An Unusual Infection of Breast Tissue

Discussion

Mycobacterium abscessus is a human pathogen commonly found in the soil, water, or sewerage. The organism is a nontuberculous mycobacterium characterized by rapid growth and a lack of pigmentation on the gram-positive rods. A review of the literature revealed multiple cases of M abscessus infection of the skin, but only one reference was made concerning breast tissues in which rapidly growing M abscessus initially was misdiagnosed as fibrocystic disease. Yasar and colleagues reported a woman with a history of fibrocystic breast disease who presented with a breast abscess later identified as M abscessus.¹ She was treated with amikacin, linezolid, and clarithromycin. The authors concluded that antimycobacterial therapy for M abscessus infection remains poorly established, and surgical therapy is often required in treating this atypical mycobacterium infection.

Two previous reports have referred to M abscessus infection in the breast tissue; however, this current case is unique. The authors believe this case study to be noteworthy in its description of an acute presentation in a woman with neither trauma nor history of breast disease, such as fibrocystic breasts. This unusual presentation makes the diagnosis of M abscessus infection more difficult to diagnose and treat in a timely manner.

Reports of M abscessus infection have been documented in skin and soft tissues. These cases involved prior trauma to the skin, such as acupuncture, filler injections, surgical procedures, or other traumatic events. Painful nodules and plaque formation also were reported with a culture showing polymorphonuclear microabscesses and granulomatous inflammation in the dermis and subcutaneous fat tissue, identified as M abscessus.^2,3

Another study reported a case of M abscessus infection after a patient had a tattoo.⁴ Possible of infections from tattoos may be localized or systemic. Because more people are being tattooed and developing skin infections resistant to standard antibiotic treatment, M abscessus infection must be considered in the differential diagnosis of these infections.

Conclusion

Mycobacterium abscessus infection is usually seen in immunocompromised hosts or those with trauma. However, as more cases of M abscessus are seen in skin and soft-tissue infections because of more cosmetic injections, body art, or minor surgical procedures, clinicians must have a high degree of suspicion for this pathogen, especially if the patient does not respond to standard antibacterial therapy. Although amikacin and clarithromycin are 2 antimicrobial agents that have shown effectiveness against this pathogen, obtaining a skin biopsy along with mycobacterial culture and sensitivity testing is determining the proper agents for successful treatment. The importance of early recognition and proper antibiotic therapy is crucial to avoid delay in diagnosis and to decrease potential tissue loss.