International Journal of STD & AIDS 1992: 3: 447
CASE REPORT
An inguinal bubo caused by Mycobacterium chelonae abscessus Peter Fisk BSc FRCP Department of Genitourinary Medicine, Leicester Royal Infinnary, Infinnary Close, Leicester LEI 5WW, UK Keywords: Inguinal bubo, Mycobacterium chelonae abscessus, HIV
Patients from overseas occasionally present to UK departments of genitourinary medicine wit~ inguinal bubos. A rare cause of such a bubo IS presented here but one which should be considered especially in' patients who may be immunosuppressed, although this patient came from an African state of low mv seroprevalence. CASE REPORT A 22-year-old African man from Nigeria present.ed with an Tl-day history of a swelling in his left grom, together with a 5-day history of headache and feverishness. His last sexual contact had been in Nigeria a month before with a regular girlfriend. On examination, he was mildly pyrexial (37.4°C) with no genital abnormality and an indurated area on the upper-outer quadrant of his ~e!t. b.utt~ck which he attributed to a 'prophylactic Injection given by his doctor before his departure for England about a month previously. Initial investigations showed a normal blood count and differential white cell count; VORL and TPHA were negative; LGV CFT < 1/16; MSU showed no growth. Routine screening for other STOs was negative. .He was empirically treated with a course of trimethoprim 200 mg twice a day, and he returned ~ week later with an erythematous fluctuant bu~o In his left groin from which 10 ml of purulent fluid was aspirated. An organism was not isolated on initial culture. He was then treated with a 7-day course of erythromycin and following t~is 10 ml of turbid fluid was drained. Treatment with doxycycline 100 mg, and metronidazole 400 mg twic~ a day was then started, but during the course of this, pus started discharging from his buttock. Surgery under general anaesthetic allowed drainage of pus both from his left buttock and groin, and he made an uneventful recovery. The 6-week culture on Lowenstein Jenson ~edium of the purulent fluid. initially drained from hIS groin showed Mycobactenum chelonae absces~us, which was distinguished from mycobactenum fortuitum by lipid analysis.
DISCUSSION
Mycobacterium chelonae and Mycobacterium fortuitum1 are morphologically similar organisms which are usually acquired by inoculation either accidentally, by surgery, or by injection. They cause a pyogenic skin abscess with ulceration and sinus formation, particularly in immunosuppressed patients, and it is unfortunate that this patient was not prepared to have an HIV antibody test performed. The incubation period of Mycobacterium chelonae infection is usually about a month, which was the case in this patient, and there is usually no evidence of spread from person to person. Treatment is by surgical drainage and debridement, together with antibioticse" such as amikacin, doxycycline, erythromycin, ciproflo~acin, imipenem ~nd. rifampicin. It was fortuitous that two efficacious antibiotics were selected for his treatment, and these, together with surgery, undoubtedly were important in the resolution of his infection. Mycobacterium chelonae is a rare cause of an inguinal bubo, but one to consider in patients who have come from areas of high seroprevalence for HIV.
Acknowledgements: I should like to thank Dr C J Mitchell, Director of the PHLS, Leicester, and Dr P A Jenkins of the Mycobacterium Reference Unit, University Hospital of Wales, for their help in identifying Mycobacterium chelonae abscessus. References 1 Hand W. Lee, Sanford Jay P. Mycobacterium fortuitum-a human pathogen. Ann Intern Med 1970;73:971-7 2 Wallace RJ [r, Swanson JM, Silcox VA, etal. Treatment of nonpulmonary infections due to Mycobacterium fortuitum and Mycobacterium chelonei on the basis of in-vitro susceptibilities. J Infect Dis 1985;152:500-14 3 Dalovisio JR, Parkey GA, Wallace RJ, etal. Clinical usefulness of amikacin and doxycycline in the treatment of infections due to Mycobacterium fortuitum and Mycol¥u:terium chelonei. RevInfect Dis 1981;3:1068-74 4 Yew WW, Kwan SY, Wong PC, LeeJ. Otloxacin and imipenem in the treatment of mycobacterium fortuitum and mycobacterium chelonae lung infections. Tubercle 1990;71:131-3
(Accepted 24 June 1992)
Downloaded from std.sagepub.com at EBSCO Electronic Journals Service (EJS) on May 26, 2016
CASE REPORT
An inguinal bubo caused by Mycobacterium chelonae abscessus Peter Fisk BSc FRCP Department of Genitourinary Medicine, Leicester Royal Infinnary, Infinnary Close, Leicester LEI 5WW, UK Keywords: Inguinal bubo, Mycobacterium chelonae abscessus, HIV
Patients from overseas occasionally present to UK departments of genitourinary medicine wit~ inguinal bubos. A rare cause of such a bubo IS presented here but one which should be considered especially in' patients who may be immunosuppressed, although this patient came from an African state of low mv seroprevalence. CASE REPORT A 22-year-old African man from Nigeria present.ed with an Tl-day history of a swelling in his left grom, together with a 5-day history of headache and feverishness. His last sexual contact had been in Nigeria a month before with a regular girlfriend. On examination, he was mildly pyrexial (37.4°C) with no genital abnormality and an indurated area on the upper-outer quadrant of his ~e!t. b.utt~ck which he attributed to a 'prophylactic Injection given by his doctor before his departure for England about a month previously. Initial investigations showed a normal blood count and differential white cell count; VORL and TPHA were negative; LGV CFT < 1/16; MSU showed no growth. Routine screening for other STOs was negative. .He was empirically treated with a course of trimethoprim 200 mg twice a day, and he returned ~ week later with an erythematous fluctuant bu~o In his left groin from which 10 ml of purulent fluid was aspirated. An organism was not isolated on initial culture. He was then treated with a 7-day course of erythromycin and following t~is 10 ml of turbid fluid was drained. Treatment with doxycycline 100 mg, and metronidazole 400 mg twic~ a day was then started, but during the course of this, pus started discharging from his buttock. Surgery under general anaesthetic allowed drainage of pus both from his left buttock and groin, and he made an uneventful recovery. The 6-week culture on Lowenstein Jenson ~edium of the purulent fluid. initially drained from hIS groin showed Mycobactenum chelonae absces~us, which was distinguished from mycobactenum fortuitum by lipid analysis.
DISCUSSION
Mycobacterium chelonae and Mycobacterium fortuitum1 are morphologically similar organisms which are usually acquired by inoculation either accidentally, by surgery, or by injection. They cause a pyogenic skin abscess with ulceration and sinus formation, particularly in immunosuppressed patients, and it is unfortunate that this patient was not prepared to have an HIV antibody test performed. The incubation period of Mycobacterium chelonae infection is usually about a month, which was the case in this patient, and there is usually no evidence of spread from person to person. Treatment is by surgical drainage and debridement, together with antibioticse" such as amikacin, doxycycline, erythromycin, ciproflo~acin, imipenem ~nd. rifampicin. It was fortuitous that two efficacious antibiotics were selected for his treatment, and these, together with surgery, undoubtedly were important in the resolution of his infection. Mycobacterium chelonae is a rare cause of an inguinal bubo, but one to consider in patients who have come from areas of high seroprevalence for HIV.
Acknowledgements: I should like to thank Dr C J Mitchell, Director of the PHLS, Leicester, and Dr P A Jenkins of the Mycobacterium Reference Unit, University Hospital of Wales, for their help in identifying Mycobacterium chelonae abscessus. References 1 Hand W. Lee, Sanford Jay P. Mycobacterium fortuitum-a human pathogen. Ann Intern Med 1970;73:971-7 2 Wallace RJ [r, Swanson JM, Silcox VA, etal. Treatment of nonpulmonary infections due to Mycobacterium fortuitum and Mycobacterium chelonei on the basis of in-vitro susceptibilities. J Infect Dis 1985;152:500-14 3 Dalovisio JR, Parkey GA, Wallace RJ, etal. Clinical usefulness of amikacin and doxycycline in the treatment of infections due to Mycobacterium fortuitum and Mycol¥u:terium chelonei. RevInfect Dis 1981;3:1068-74 4 Yew WW, Kwan SY, Wong PC, LeeJ. Otloxacin and imipenem in the treatment of mycobacterium fortuitum and mycobacterium chelonae lung infections. Tubercle 1990;71:131-3
(Accepted 24 June 1992)
Downloaded from std.sagepub.com at EBSCO Electronic Journals Service (EJS) on May 26, 2016
