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Mycobacterium abscessus Soft Tissue Disease of the Abdominal Wall

Case Report and Review of the Literature

Rodriguez, Vivian Vega, MD; Oehler, Richard L., MD

Infectious Diseases in Clinical Practice: September 2018 - Volume 26 - Issue 5 - p 258–263
doi: 10.1097/IPC.0000000000000646
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Rapidly growing mycobacteria (RGM) are widely distributed in nature and known to be able to withstand extremes of temperature and nutritionally austere environments. They have been isolated from soil, dust, water, terrestrial and aquatic animals, hospital environments, and contaminated reagents and pharmaceuticals. The Mycobacterium abscessus complex group is considered the most significant set of human pathogens among the RGM. M. abscessus complex includes 3 subspecies: M. abscessus subspecies abscessus, M. abscessus subspecies massiliense, and M. abscessus subspecies bolletii. M. abscessus complex can cause a wide range of clinical manifestations and is responsible for most lung infections associated with the rapid growers. Extrapulmonary manifestations have included infections of the skin and soft tissue, prosthetic devices, surgical site infections, and disseminated disease associated with profound immunosuppression.

In this report, we present a case of intra-abdominal M. abscessus presenting as an enlarging mass in a patient on chronic corticosteroid therapy. Cases of intra-abdominal M. abscessus complex infections are limited in the published literature, and the treatment approach for these infections has not been consistent. Furthermore, M. abscessus complex has acquired the reputation of being the most virulent and chemotherapy-resistant member of the RGM group. As a result, the management of such infections is complicated and lacks specific guidance.

The authors present a case of intra-abdominal Mycobacterium abscessus presenting as an enlarging mass in a patient on chronic corticosteroid therapy. Cases of intra-abdominal M. abscessus complex infections are limited in the medical literature, and their management and pharmacologic treatment has not been consistent. The authors review the established literature for these infections and outline specific therapeutic and supportive management options.

From the Division of Infectious Diseases and International Medicine, USF Morsani College of Medicine, Tampa, FL.

The authors have no conflicts of interest to disclose.

Correspondence to: Richard L. Oehler, MD, 13,000 Bruce B Downs Blvd, No. 111J, Tampa, FL 333612. E-mail: Richard.oehler@va.gov.

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