Sporotrichoid Mycobacterium marinum skin infection treated with minocycline hydrochloride

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Mycobacterium marinum is the most commonly reported cause of atypical mycobacterial skin infections. The infections usually resolve spontaneously within 3 years, but have occasionally persisted for more than 40 years.1–3 The chemotherapeutic approach to treatment of the infections by internists and specialists in infectious diseases has been with various combinations of ethambutol, isoniazid, and rifampin.4–6 Several recent reports by dermatologists have documented the effectiveness of treatment with tetracycline hydrochloride and minocycline hydrochloride.6–9 Our patient had the sporotrichoid variety of M. marinum infection and responded rapidly to treatment with minocycline hydrochloride.

Case report

A small lump developed on the right dorsal fourth finger of a 54-year-old black woman in February 1977. The lesion did not heal and 2 weeks later similar lesions appeared on the right dorsal hand and forearm. Most of the lesions gradually became larger but were not painful. The patient felt well and had no fever or chills. Several of the lumps decreased in size spontaneously during a 4-week period leaving small residual lumps in the skin.

A dermatologist was consulted in April 1977, and skin biopsy specimens from the right wrist showed “acute and chronic granulomatous inflammation.” Cultures and special histochemical stains were negative for deep fungus and acid-fast organisms.

Treatment with liquid nitrogen, iodo-chlorhydroxyguin-hydrocortisone cream, gentamicin sulfate 0.1% cream, and erythromycin given orally had no effect.

The patient was a homemaker and also did custodial work in a hospital. She did not recall receiving any traumatic injuries to the right hand or fingers . . .



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