Tuan Hoang Thanh, Ngoc Nguyen Anh, Ai Luu Dang, Van Luat Nguyen
Hoang Tuan Clinic, Hoang Quoc Viet, Hanoi, Vietnam.
Aesthetic Plast Surg. 2024 Apr;48(7):1365-1385. doi: 10.1007/s00266-023-03512-x. Epub 2023 Aug 2.
Mycobacterium abscessus infection after liposuction/fat grafting is a rare complication that is hard to diagnose and treat. Misdiagnosis could result in treatment failure and prolonged hospital stays. The paradoxical reaction is another complication that rarely occurs in non-HIV patients infected with nontuberculosis mycobacteria. This study reported 3 cases infected with M. abscessus complicated by the paradoxical reaction after liposuction and fat grafting. It highlighted characteristics giving clues of the paradoxical reaction and a successful strategy. Also, a systematic review was conducted to comprehensively provide varied aspects of M. abscessus infection after liposuction and/or fat grafting.
Three cases were retrospectively included reporting data characteristics of patients, cosmetic procedures, and treatment strategy. PubMed, Scopus, Virtual Health Library (VHL), and Global Health Library (GHL) were searched to find and include cases with M. abscessus infection after liposuction and/or fat grafting based on defined selection criteria. Relevant data were extracted and summarized. The risk of bias in included studies was assessed using JBI critical appraisal checklists.
Twenty-four articles were included in the systematic review. Symptoms often developed approximately 1 month after the cosmetic surgery. Culture, AFB, and PCR were common methods of diagnosis of M. abscessus after liposuction and/or fat grafting. It took about 33 days on average from the presentation to isolate and detect the pathogens. Antibiotics based on susceptibility testing results along with surgical interventions were effective methods of treatment. Our three cases which were complicated by the paradox were addressed by adding methylprednisolone for 2 weeks to the macrolide-based therapy.
Awareness of this disease should be widely raised among physicians for early diagnosis and proper treatments. Cultures of specimens and AFB should be repeated many times before excluding the possibility of Mycobacterium spp. A paradoxical reaction should be suspected if the symptoms were worse after the antibiotic therapy based on susceptibility testing results and proper surgical interventions, especially if patients had taken corticosteroids before being admitted.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
抽脂/脂肪移植后脓肿分枝杆菌感染是一种罕见的并发症，难以诊断和治疗。误诊可能导致治疗失败和住院时间延长。反常反应是另一种在非结核分枝杆菌感染的非艾滋病患者中很少发生的并发症。本研究报告了3例抽脂和脂肪移植后感染脓肿分枝杆菌并伴有反常反应的病例。它突出了提示反常反应的特征和成功的治疗策略。此外，还进行了一项系统评价，以全面提供抽脂和/或脂肪移植后脓肿分枝杆菌感染的各个方面。
回顾性纳入3例病例，报告患者的数据特征、美容手术和治疗策略。检索PubMed、Scopus、虚拟健康图书馆（VHL）和全球健康图书馆（GHL），根据既定的选择标准查找并纳入抽脂和/或脂肪移植后感染脓肿分枝杆菌的病例。提取并总结相关数据。使用JBI批判性评价清单评估纳入研究的偏倚风险。
系统评价纳入了24篇文章。症状通常在美容手术后约1个月出现。培养、抗酸杆菌（AFB）和聚合酶链反应（PCR）是抽脂和/或脂肪移植后诊断脓肿分枝杆菌的常用方法。从出现症状到分离和检测病原体平均需要约33天。根据药敏试验结果使用抗生素并结合手术干预是有效的治疗方法。我们的3例伴有反常反应的病例，在基于大环内酯类的治疗基础上加用甲基泼尼松龙2周进行处理。
应在医生中广泛提高对这种疾病的认识，以便早期诊断和进行适当治疗。在排除分枝杆菌属的可能性之前，应多次重复标本培养和抗酸杆菌检测。如果根据药敏试验结果和适当的手术干预进行抗生素治疗后症状加重，尤其是患者在入院前曾服用过皮质类固醇，则应怀疑反常反应。
证据水平III：本刊要求作者为每篇文章指定证据水平。有关这些循证医学评级的完整描述，请参阅目录或在线作者指南www.springer.com/00266。
