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Mycobacterium fortuitum Breast Infection After Nipple Ring Placement: Case Presentation and Review of the Literature

Maroun, Elias N. MD*; Chakrabarti, Amrita MD; Sandin, Ramon L. MD, MS, FCAP; Greene, John N. MD, FACP§

Infectious Diseases in Clinical Practice: September 2012 - Volume 20 - Issue 5 - p 309–311
doi: 10.1097/IPC.0b013e318255d530
Review Articles

Introduction Mycobacterium fortuitum is a rapid-growing nonphotochromogenic, nontuberculous mycobacterium. It is potentially pathogenic, producing lesions in the lung, bone, or soft tissue after trauma, injury, or surgery. It can be found in soil, dust, and water. It has been found in injection sites of human, cattle, and cold-blooded animals. Rapidly growing mycobacteria (RGM) are also known as “Runyon Group IV,” as they are able to grow in cultures within 7 days. Only a few cases of M fortuitum breast infection have been reported, including one that was suspected to be a case of breast carcinoma.

Case Presentation Here, we present a case of a 42-year-old woman with M fortuitum breast infection after nipple ring placement. The patient presented with a tender and painful red nodule on the breast several months after nipple piercing. Biopsy of the lesion ruled out malignancy and revealed necrotizing granuloma with acute and chronic inflammatory changes. Cultures obtained from the lesion grew M fortuitum complex. The patient required multiple drainages and was successfully treated with 4 months of levofloxacin and azithromycin.

Conclusion As the prevalence of body piercing continues to increase, the probability of infection with RGM becomes higher and should be considered as a differential diagnosis in skin infections with a history of body piercing. Our case report emphasizes the importance of RGM in skin infections after body piercing and the need for obtaining cultures including those for mycobacteria.

From the *Division of Infectious Diseases and International Medicine, University of South Florida College of Medicine, Tampa, FL; †Moffitt Cancer Center and Research Institute, Tampa, FL; ‡Clinical Microbiology and Virology Laboratories; Moffitt Cancer Center and Research Institute; and University of South Florida College of Medicine, Tampa, FL and §Moffitt Cancer Center and Research Institute; and University of South Florida College of Medicine, Tampa, FL.

Correspondence to: John N. Greene, MD, FACP, Moffitt Cancer Center and Research Institute; University of South Florida College of Medicine, 12902 Magnolia Dr, Mailstop: FOB-3, Tampa, FL 33612-9497. E-mail:

The authors have no funding or conflicts of interest to disclose.

© 2012 Lippincott Williams & Wilkins, Inc.