Mycobacterium chelonae infection complicating cosmetic facial surgery

Polymicrobial Extensor Tenosynovitis Including Mycobacterium chelonae Caused by a Dog Bite: A Case Report

CASE

A nonimmunocompromised 77-year-old man was bitten in the hand by his dog; redness, swelling, and exudate developed. Despite debridement and medications administered at another hospital, his symptoms did not improve. He was referred to us after 3 months. Debridement and negative-pressure wound therapy was performed. Cultures were positive for multiple bacterial organisms, including Mycobacterium chelonae. Polymicrobial extensor tenosynovitis including M. chelonae was diagnosed. Clarithromycin was given for 7 months based on drug sensitivity. His symptoms did not recur.

CONCLUSION

Mycobacterium chelonae infections after dog bites are rare; however, mycobacterial culture tests are important, especially if tissue shows granulomatous inflammation.

Prevention and Management of Serious Complications After Facial Fat Grafting

Facial fat grafting is increasing worldwide. Although there are few reports in the literature on complications following facial lipofilling, rare but serious complications include embolic risk to local end organs such as the skin and eye, and the central nervous system. Treatment strategies are outlined. The key to prevention of complications is understanding the regional anatomy. It is imperative to adhere to the safe and efficacious techniques to minimize risk. Every surgeon who performs facial fat grafting should establish a systematic method to deliver safe, consistent, and long-term results for their patients.

Mycobacterium chelonae hand infection following ferret bite

We present a case of hand infection caused by Mycobacterium chelonae. The patient was a 58-year-old woman with Type II diabetes mellitus and stage 4 chronic kidney disease. The infection occurred following a ferret bite and had not responded to oral antibiotics in the primary care setting. She developed signs of pyogenic flexor tenosynovitis of the index and middle fingers of her left hand. Laboratory parameters showed high C-reactive protein, raised erythrocyte sedimentation rate and leucocytosis. Ultrasound imaging confirmed the clinical diagnosis. Plain radiographs showed no osseous involvement. The infection was treated with surgical debridement and broad spectrum parenteral antibiotics. The intra-operative tissue specimens were initially negative on aerobic and anaerobic cultures. Following transient improvement of her inflammatory parameters and clinical signs, she developed a recurrence with added features of osteomyelitis of the index and middle finger metacarpal heads on repeat radiographs. A revision surgical debridement of the flexor tenosynovitis and osteomyelitis with specific long-term antibiotic cover has led to resolution of the infection. Extended cultures of the tissue specimens at the regional laboratory confirmed the causative organism to be M. chelonae. To our knowledge, this is the first reported case of M. chelonae infection resulting from a ferret bite. This case reminds us of the need for a high index of suspicion for infection with uncommon pathogens following animal bites, especially in patients with altered immune status.