Nontuberculous Mycobacterial Infections after Aesthetic Procedures: Comparison of Clinical Features and Treatment

Abstract

Nontuberculous mycobacteria (NTM) have been increasingly identified as causative of numerous cosmetic procedure related infections worldwide. This manuscript reports clinical aspects and antimicrobial resistance profiles of NTM infections associated with aesthetic procedures diagnosed in a private infectious disease clinic in the Brazilian Amazon. Four patients developed skin and soft tissue infections between August 2015 and August 2019. Clinical, microbiological, and epidemiological data were collected. M. conceptionense, M. abscessus and M. fortuitum were isolated. The histopathology showed dermal granulomatous inflammation. All patients were treated with a combination of antimycobacterial regimens, mainly with moxifloxacin and clarithromycin.

Keywords: Nontuberculous mycobacteria; aesthetic procedures; treatment.

FIGURE 1.

Photograph of lesions associated with nontuberculous mycobacterial infections. A) Patient 1: erythematous to violaceous plaques and nodules on the shoulder. B) Cicatricial region after 12 months of treatment with oral moxifloxacin 400mg daily and oral clarithromycin 500mg BID. C) Patient 2: Cicatricial region after treatment with clarithromycin (500mg BID) and moxifloxacin (400mg twice daily) for six months. D) Patient 4: Multiple abscesses in the gluteal region

FIGURE 2.

Histopathological aspects associated with nontuberculous mycobacterial lesions; A) Patient 1: adipose tissue with cystic formations involved by foreign body type granulomatous formations; B) Patient 2: A poorly formed granuloma, with lymphocytes, histiocytes, neutrophils, and epithelioid cells; C) Patient 3: Granulomatous infiltrate, with lymphocytes, histiocytes, epithelioid cells, and scant plasma cells; Patient 4: D) Epidermis with slight acanthosis. In the dermis, granulomatous infiltrate, with lymphocytes, histiocytes, epithelioid cells, and vascular neoformation.