Johanis Michael, Cheema Karan S, Young Peter A, Bae Gordon H
Department of Dermatology, Stanford University School of Medicine, Palo Alto, USA.
School of Public Health, Brown University, Providence, USA.
Cureus. 2024 Jun 13;16(6):e62336. doi: 10.7759/cureus.62336. eCollection 2024 Jun.
The incidence of nontuberculous mycobacteria infections has surged over recent decades. is one example that can present unique diagnostic challenges due to its variable antibiotic resistance profile and its clinical similarities to in postodontogenic infections. The authors report a case of a 22-year-old healthy female presenting with bilateral mandibular nodules following wisdom teeth extraction. After a presumptive diagnosis of actinomycosis, cultures revealed a infection susceptible to macrolides. Magnetic resonance imaging depicted bilateral sinus tracts without osteomyelitis. The patient opted for dual antibiotic therapy, consisting of azithromycin and omadacycline, without surgical intervention. Given her clinical and radiographic improvement after three months, the patient elected to continue dual antibiotic therapy for 12 months with appropriate clinical and radiographic monitoring. This case underscores the importance of early microbial cultures to guide diagnosis and treatment, particularly considering 's similarities with other pathogens and its variable macrolide susceptibility due to genetic mutations. As highlighted in this case, clinicians must successfully differentiate between and appropriately treat various nontuberculous mycobacteria.
近几十年来，非结核分枝杆菌感染的发病率急剧上升。由于其可变的抗生素耐药性谱以及在牙源性感染后与其他疾病的临床相似性，它是一个可能带来独特诊断挑战的例子。作者报告了一例22岁健康女性在拔除智齿后出现双侧下颌结节的病例。在初步诊断为放线菌病后，培养显示为一种对大环内酯类敏感的非结核分枝杆菌感染。磁共振成像显示双侧窦道，无骨髓炎。患者选择了由阿奇霉素和奥马环素组成的双重抗生素治疗，未进行手术干预。鉴于三个月后她的临床和影像学有所改善，患者选择继续双重抗生素治疗12个月，并进行适当的临床和影像学监测。该病例强调了早期微生物培养对指导诊断和治疗的重要性，特别是考虑到该菌与其他病原体的相似性以及由于基因突变导致的可变大环内酯敏感性。正如本病例所强调的，临床医生必须成功区分并适当治疗各种非结核分枝杆菌。
