Preseptal cellulitis due to Mycobacterium marinum

Preseptal cellulitis due to Mycobacterium marinum

J Laryngol Otol. 2006 Dec 14

Benton J,
Karkanevatos A.

ENT Department, Leighton Hospital, Crewe, UK.

Mycobacterium marinum is an atypical mycobacterium found in both salt and fresh water. It occasionally causes soft tissue infections after minor trauma, principally affecting the limbs.A 17-year-old male aquarium worker presented with preseptal cellulitis of his right eye, after attempting to lance a hordeolum some days previously. The condition failed to respond to antibiotics and a necrotic area developed, which subsequently required debridement. Histology of the debrided area demonstrated granulomatous inflammation which when considered with his occupation led to the diagnosis of Mycobacterium marinum - 'fish-tank granuloma'.A Medline search did not demonstrate any previous cases of Mycobacterium marinum infection occurring peri-orbitally. The current literature regarding diagnosis and management is reviewed. Although infection with Mycobacterium marinum is rare in the general population, this case demonstrates the importance of considering the diagnosis when dealing with patients frequently exposed to fresh or salt water.

PMID: 17166324 [PubMed - as supplied by publisher]

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Related Abstracts

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Disseminated Mycobacterium marinum infection with extensive cutaneous eruption and bacteremia in an immunocompromised patient.

Eur J Dermatol. 2006 Jan-Feb;16

Streit M,
Bohlen LM,
Hunziker T,
Zimmerli S,
Tscharner GG,
Nievergelt H,
Bodmer T,
Braathen LR.

Department of Dermatology, Inselspital, University of Bern, 3010 Bern, Switzerland. markus.streit@insel.ch

Mycobacterium marinum can cause fish tank granuloma (or swimming pool or aquarium granuloma) in immunocompetent patients. Dissemination of Mycobacterium marinum-infection is a rare condition which occurs mainly in immunocompromised patients and can be life-threatening. We report the case of an 87-year-old woman who was treated with oral corticosteroids for polymyalgia rheumatica for many years and developed erythema nodosum-like lesions on the right forearm and arthritis of the right wrist. By increasing the steroid dosage and adding methotrexate only short-term remission was achieved. Seven months later painful erythematous nodules occurred on all extremities which became necrotic, ulcerative and suppurative. Ziehl-Neelsen staining revealed acid-fast bacilli and Mycobacterium marinum was cultured from skin biopsies, blood, and urine. The critically ill patient was treated with clarithromycin and ethambutol resulting in a dramatic improvement of the general condition. After four months, doxycycline had to be added because of new skin lesions. This case illustrates the impact of Mycobacterium marinum infection in immunocompromised patients.

Keywords : clarithromycin, disseminated infection, public open-air whirlpool, immunosuppression, Mycobacterium marinum, panniculitis

John Libbey Eurotext

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Mycobacterium marinum arthritis mimicking rheumatoid arthritis.

J Rheumatol. 2006 Apr

Rheumatology Division, Department of Medicine, The University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903-0019, USA.

Mycobacterium marinum is an atypical mycobacterium found in salt and fresh water. M. marinum infection occurs following skin trauma in fresh or salt water and usually presents as a localized granuloma or sporotrichotic lymphangitis. It rarely affects the musculoskeletal system. We describe a patient who presented with subcutaneous nodules and an inflammatory arthritis that was thought to be rheumatoid arthritis, and was treated as such with corticosteroids, methotrexate, and anti-tumor necrosis factor-alpha therapy, with worsening of his arthritis.

Journal of Rheumatology

Bacterial cellulitis. Forms borderline between medical and surgical (3 cases)

Bacterial cellulitis. Forms borderline between medical and surgical (3 cases)

• Pavlovic M,
• Le Breton C,
• Granier F,
• Fouchard N,
• Saiag P.

Service de Dermatologie, Hopital Ambroise Pare, Boulogne, France.

BACKGROUND:

An acute infectious cellulitis may be managed medically (erysipelas or non-necrotizing infectious cellulitis) or surgically (necrotizing infectious cellulitis, necrotizing fasciitis). We report 3 cases of non-necrotizing infectious cellulitis borderline between medical and surgical forms, complicated by compartment syndrome, the surgical decompression of which permitted patients' cure.

CASE REPORTS:

Three patients, 27, 52 and 84 years old, were admitted for an acute infectious cellulitis of the leg. At admission, the leg area involved was erythematous, painful, indurated, with one or several bullae, purpura, pustules, hypoesthesia or limited skin necrosis, and no immediate need for surgical exploration. The clinical evolution was characterized by the slow appearance or extension of signs of severity, despite the modification in antibiotic treatment. Magnetic resonance imaging findings were indicative of a non-necrotizing infectious cellulitis in 2 patients. In one patient, necrotizing fasciitis could not be excluded. In all patients, surgical exploration showed an important quantity of non-purulent fluid between muscles and hypodermis, with no evidence of abscess or necrosis. A large incision rapidly cured all patients.

DISCUSSION:

These three observations were characterized by the initial signs of moderate severity and no response to an appropriate medical treatment, which led to surgical exploration. Surgery showed no abscess or necrosis but an important quantity of sterile fluid; it also permitted rapid cure of patients. These cases present a borderline form of infectious cellulitis, with severe local inflammation caused by a compartment syndrome. Surgical decompression was needed for cure. The potential value of magnetic resonance imaging in this situation should also be stressed.

Masson.fr

An eye for trouble: orbital cellulitis.

An eye for trouble: orbital cellulitis.

Armstrong PA,
Nichol NM.

Emergency Department, Ninewells Hospital, Dundee DD1 9SY, UK. peter.armstrong@nhs.net

Patients with orbital cellulitis present to emergency departments occasionally. Symptoms usually develop rapidly, with patients being distressed by painful ocular movements and systemic upset. The case of a 24-year-old man who had a 1-month gradual history of intermittent periorbital swelling after a flu-like illness, and subsequently developed a large intracranial extradural abscess eroding through the temporal bone, ultimately requiring neurosurgical intervention is presented. Although orbital and periorbital swelling is common after acute sinusitis, cellulitis and intracranial abscess are rare but potentially life threatening and sight threatening. Accurate diagnosis is therefore of great importance. In this case, the patient presented with few clinical signs but relevant pathology. The importance of assessing ocular movement, which is a major clinical abnormality indicating orbital disorder and thus an aid to accurate diagnosis, should be highlighted.

British Medical Journal