References
Care and treatment of a rare mycobacterium avium complex-infected wound: a case report
Abstract
An unusual presentation of Mycobacterium avium complex (MAC), unlikely to be encountered in an outpatient dermatology setting, was diagnosed in a patient without an immunodeficiency. A 47-year-old woman, who was immunocompetent and had no risk factors, presented with a full-thickness, infected wound (large amounts of purulent exudate and severe pain) on her back, which had been present for two months. She was diagnosed as having an MAC infection, using a DNA microarray chip method. The patient underwent wound drainage and a fresh silver-containing dressing was applied daily for two months. Although systemic antibiotics were given for one week and anti-tuberculous medication for one month, there was no response. She also complained of bloating, nausea, loss of appetite and other problems, apparently due to drug-induced liver damage, confirmed by laboratory tests. Based on her characteristics and a literature review related to MAC infection, we implemented an individualised, holistic care protocol for the patient that included a daily diet of appropriate fresh vegetables and fruits, and adequate high-quality protein, aerobic exercises for two hours per day, and sleep for 6–8 hours per day, to alleviate the iatrogenic liver damage, improve immune function and reduce the stress response. The wound continued treatment with sharp debridement as needed, and fresh antimicrobial silver-containing dressings every other day. Wound size was measured once a week to evaluate the effects. The wound healed after 48 days, and the patient was followed-up for 18 months at the outpatient wound care centre and through social media. No recurrence or scar hyperplasia was observed.
Mycobacterium avium complex (MAC), which comprises non-tuberculous mycobacteria (NTM), is widely distributed in the environment and is the most common mycobacteria in patients with pulmonary NTM, but rarely found in infected wounds.1,2 Older people and immunodeficient or immunocompromised individuals are most susceptible.1,3 Usually, the lungs, bone marrow and lymph nodes are invaded, 2,4–6 and the skin is infected, presenting as panniculitis, cutaneous granulomas, pustules, ulcerations, and erythematous skin lesions.1
Medications have limited effects on MAC and can produce toxic side effects in some patients.2,7,8 In addition, research has shown that clinical manifestations differ among cases, and thus diagnosis of MAC-infected wounds is difficult, with little consensus on the characteristics.9,10 Most MAC infections involve the lung or chest, causing fever, cough, dyspnea, chest pain, and/or progressive pulmonary nodules.2,4,5,6 Occasional cases of disseminated cutaneous lesions1 and intracranial central nervous system infection11 have been reported.
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