Parasitology, Naval Medical Research Unit No 6, Callao, Peru
Infectious Disease, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
BMJ Case Rep. 2021 Feb 4;14(2):e237618. doi: 10.1136/bcr-2020-237618.
A 40-year-old woman was referred to infectious disease specialists for a skin infection following mastectomy and bilateral reconstruction with deep inferior epigastric perforator flap. Her case demonstrates the difficulty in treating non-tuberculosis mycobacterial infections, especially the rarely seen species. She failed to respond to dual antibiotic therapy containing imipenem-cilastin despite reported sensitivity. Additionally, her course was complicated by intolerance to various regimens, including gastrointestinal distress, a drug rash with eosinophilia and systemic symptoms, and tendinopathy. With few published data, no treatment guidelines, and limited medications from which to choose for her treatment posed a challenge. She ultimately required aggressive surgical intervention and a triple therapy antibiotic regimen. The duration of our patient's treatment and the extent of her complications suggest a potential need for early surgical intervention in postsurgical wounds infected with that do not respond to conventional treatment.
一位 40 岁女性因乳房切除术和双侧腹壁下动脉穿支皮瓣重建术后皮肤感染，被转介至传染病专家处。她的病例说明了治疗非结核分枝杆菌感染的困难，尤其是那些罕见的菌种。尽管报告显示她对亚胺培南-西司他丁敏感，但她对包含该药物的双联抗生素治疗无反应。此外，她还因对各种方案不耐受而使病程复杂化，包括胃肠道不适、伴有嗜酸性粒细胞增多和全身症状的药物疹以及腱病。由于数据有限，没有治疗指南，可供选择的药物也有限，这对她的治疗构成了挑战。她最终需要进行积极的手术干预和三联抗生素治疗方案。我们的患者治疗时间长，并发症多，这表明对于手术后感染且对常规治疗无反应的伤口，可能需要早期进行手术干预。
