Clin Lab. 2024 Oct 1;70(10). doi: 10.7754/Clin.Lab.2024.240518.
In March 2024, our hospital confirmed a case of Mycobacterium fortuitum infection in the left thigh. In January 2024, the patient underwent buttock augmentation surgery at a private plastic surgery hospital. One month after the surgery, the patient sought medical attention at the plastic surgery hospital, due to pain in both legs while sitting. Upon examination, two subcutaneous masses were found in the left thigh, the tumors were painful to pressure, with obvious redness and swelling and elevated skin temperature; therefore, the patient was treated with intravenous infusion (cephalosporin drugs), but after one month of treatment, no significant improvement was observed. In order to seek additional diagnosis and treatment, the patient came to our hospital for treatment.
Clinical treatment of the left lower limb included wound debridement, abscess incision and drainage, and photodynamic therapy with 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT). During surgery, subcutaneous tough tissue was taken for pathogen examination, including acid fast staining, bacterial culture, and identification. Additional auxiliary examinations: urine routine, blood routine, coagulation function, liver function, kidney function, blood lipids, and blood sugar.
Bacterial acid-fast staining: positive. Bacterial Culture and Identification (MALDI-TOF MS): Mycobacterium fortuitum. Clinical treatment plan: clarithromycin 500 mg po bid, moxifloxacin 400 mg po qd, abscess incision and drainage, ALA-PDT. After 24 days of treatment, the patient's condition was good, the surgical incision healed well, there was no bleeding, exudation, or bruising, no redness, swelling, or tenderness, and the skin temperature was normal. The patient improved and was discharged.
This article reports a case of Mycobacterium fortuitum infection in the left thigh. The Mycobacterium fortuitum was quickly and accurately identified by MALDI-TOF MS, and reasonable treatment measures were adopted clinically. The patient improved and was discharged. I hope that in the future, this study can provide assistance for the clinical diagnosis and treatment of Mycobacterium fortuitum infections.
2024 年 3 月，我院确诊 1 例左大腿分枝杆菌感染病例。2024 年 1 月，患者在某民营整形医院行臀部隆臀术。术后 1 个月，患者因坐时双下肢疼痛就诊于该整形医院，左大腿触及 2 处皮下肿物，压痛明显，红肿热痛明显，予头孢类药物静滴治疗，但治疗 1 个月后，未见明显好转。为求进一步诊治，来我院就诊。
左下肢临床治疗包括伤口清创、脓肿切开引流，以及 5-氨基酮戊酸介导的光动力疗法（ALA-PDT）。术中取皮下坚韧组织送检病原学检查，包括抗酸染色、细菌培养及鉴定。辅助检查：尿常规、血常规、凝血功能、肝功能、肾功能、血脂、血糖。
细菌抗酸染色：阳性。细菌培养及鉴定（MALDI-TOF MS）：分枝杆菌属-偶然分枝杆菌。临床治疗方案：克拉霉素 500mg po bid，莫西沙星 400mg po qd，脓肿切开引流，ALA-PDT。治疗 24 天后，患者病情好转，手术切口愈合良好，无出血、渗出、瘀斑，无红肿、压痛，皮温正常。患者好转出院。
本文报道 1 例左大腿分枝杆菌感染病例。MALDI-TOF MS 快速准确地鉴定分枝杆菌属-偶然分枝杆菌，临床采取合理的治疗措施，患者好转出院。希望本研究能为分枝杆菌感染的临床诊治提供帮助。
