The surgical management of superficial infections caused by atypical mycobacteria.

We have recently treated four patients with atypical mycobacterial skin infections. Two patients were infected with Mycobacterium smegmatis after self-injection with a veterinary-grade anabolic steroid. To our knowledge, this complication has not been previously described. The other patients had steroid-dependent asthma and lower extremity infections involving M. kansasii and M. chelonei after minor household trauma developed. Atypical mycobacterial skin infections may be seen as chronic ulcerations with violaceous edges, rolled margins, and significant subcutaneous necrosis. An indolent course and the clinical appearance may aid in diagnosis. In our experience, limited incision and drainage or dressing changes fail to eradicate these infections, even when accompanied by appropriate antibiotic therapy. Successful treatment requires aggressive debridement of all infected subcutaneous tissues and skin. Split-thickness skin grafting was successfully used to cover large wounds. Grafting did not appear to foster recurrent infection.