Mycobacterium marinum: A Case-Based Narrative Review of Diagnosis and Management

Abstract

Skin and soft tissue infections caused by non-tuberculous mycobacteria are occurring more frequently in recent years. However, chronic skin and soft tissue lesions present a challenge for clinicians, as the diagnostic work-up and definitive diagnosis require knowledge and available laboratory resources. We present here the case of a 66-year-old male patient who presented with painful abscess-like nodules on his right hand and forearm, which worsened after treatment with an anti-TNF-a agent. The fluid specimen taken from the lesion was positive for mycobacteria according to the acid-fast stain. Mycobacterium marinum was identified, first by next-generation sequencing and finally grown on culture, after eight weeks. Acknowledging the complexity of diagnosing and managing infections by non-tuberculous mycobacteria, and especially Mycobacterium marinum, we provide a review of the current epidemiology, clinical characteristics, diagnosis and management of Mycobacterium marinum infection.

Keywords: Mycobacterium marinum; mycobacteria; mycobacterial infections; non-tuberculous mycobacteria; skin and soft tissue infection; skin lesions.

Figure 1

Skin ulcer on the second finger of the right hand, near the metacarpophalangeal joint, with raised borders, a dark-red color, and a base crater with yellowish exudate. Also illustrated are several small to moderate size abscesses on the right forearm, extending up to the elbow, with lymphangitic spread.