Cutaneous tuberculosis after mesotherapy: report of six cases
Keywords:
tuberculosis cutánea, Mycobacterium tuberculosis, estudios de casos
Abstract
Introduction. Cutaneous tuberculosis as a result of a needle injection is a rare event; it generally occurs among medical and laboratory personnel and among patients receiving percutaneous treatment.Objective. Six patients are presented who developed cutaneous tuberculosis after mesotherapy cosmetic treatment.
Material and methods. One to four months after injection of an unknown product as treatment for obesity and cellulites, five women and a man developed papules, nodules and drainage of wax like material at the inoculated sites; this was interpreted clinically as a non tuberculous mycobacterium infection. Skin biopsies were taken for a histopathologic study; the biopsy and exudates were cultured to make a phenotypic identification. Polymerase chain reaction and restriction enzyme pattern analyses (PCR-restriction pattern analysis)) procedures were applied to the skin biopsies.
Results. Mycobacterium tuberculosis was confirmed in the culture and by PRA analysis in the paraffin-embedded biopsies. The patients had never had tuberculosis. Their thoracic X rays were normal and the size of the tuberculin reaction was 17 to 20 mm. Five patients recovered with antituberculosis treatment and the sixth spontaneously healed after the removal of the largest cutaneous module. No satellite adenopathy or recurrences were observed.
Conclusions. A previously undescribed mode of acquisition cutaneous tuberculosis was described. This was the second incident of a demonstrated cutaneous tuberculosis following mesotherapy in Colombia. Skin lesions induced by injections must be tested to detect mycobacterias to include M. tuberculosis.
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References
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7. Sañudo A, Vallejo F, Sierra M, Hoyos JG, Yepes S, Wolf JC, et al. Nontuberculous mycobacteria infection after mesotherapy: preliminary report of 15 cases. Int J Dermatol. 2007;46:649-53.
8. Kent P, Kubica G. Public health mycobacteriology. A guide for the level III laboratory. Atlanta, Georgia: US Department Services, Centers for Disease Control; 1985.
9. Canneti G, Wallac FA, Khomenko A. Advances in techniques of testing mycobacterial drugs sensitivity and the use of sensitivity tests in tuberculosis control programs. Bull World Health Organ. 1969;41:21-43.
10. van Soolingen DV, De Hass PE, Kremer K. Restriction fragment length polymorphism (RFLP) typing of Mycobacteria. Bilthoven, The Netherlands: National Institute of Public Health and the Environment; 2002.
11. Burgos MV, Méndez JC, Ribón W. Molecular epidemiology of tuberculosis: methodology and applications. Biomédica 2004;24(Suppl.1):188-201.
12. Telenti A, Marchesi F, Balz M, Bally F, Bottger EC, Bodmer T. Rapid identification of Mycobacteria to the species level by polymerase chain reaction and restriction enzyme analysis. J Clin Microbiol. 1993;31:175-8.
13. Rodríguez G, Ortegón M, Camargo D, Orozco LC. Iatrogenic Mycobacterium abscessus infection: histopathology of 71 patients. Br J Dermatol. 1997;136:214-8.
14. Burman WJ, Reves RR. Review of false-positive cultures for Mycobacterium tuberculosis and recommendations for avoiding unnecessary treatment. Clin Infect Dis. 2000;31:1390-5.
15. Díaz BM, Muñoz OA, Klinger JC. Mycobacterium tuberculosis responsible for cutaneous disease after percutaneal inoculation of solutions: a case report. Int J Dermatol. 2003;42:564-6.
16. Ebrill D, Elek S. Tuberculous abscess following intramuscular penicillin. Lancet 1946;ii:379-80.
17. Tomar RP, Gupta A, Wilkhoo NS, Bhalla PJ. Tubercular abscess following intramuscular injections. Armed Forces Med J India. 2007;63:374-5.
18. de Jong JW, van Altena R. Non-respiratory tuberculosis with M. tuberculosis after penetrating lesions of the skin: five case histories. Int J Tuberc Lung Dis. 2000;12:1184-7.
19. Oka S, State M. 13 years follow up study of an epidemic inoculation tuberculosis in children caused by vaccination against Pertussis. Am Rev Resp Dis. 1963;88:462-5.
20. Genné D, Siegrist HH. Tuberculosis of the thumb following a needlestick injury. Clin Infect Dis. 1998;26:210-1.
21. Kramer F, Sasse SA, Simms JC, Leedom JM. Primary cutaneous tuberculosis after a needlestick injury from a patient with AIDS and undiagnosed tuberculosis. Ann Intern Med. 1993;119:594-5.
22. Oymak SF, Gülmez I, Demir R, Ozesmi M. Transmission of Mycobacterium tuberculosis by accidental needlestick. Respiration. 2000;67:696-7.
23. Barbagallo J, Tager P, Ingleton R, Hirsch R, Weinberg JM. Cutaneous tuberculosis. Diagnosis and treatment. Am J Clin Dermatol. 2002;3:319-28.
24. Grayson W, Calonge E, McKee P. Infectious diseases of the skin. Tuberculosis. In: McKee P, Calonge E, Granter SR, editors. Pathology of the skin with clinical correlation. Third edition. Philadelphia: Elsevier Mosby; 2005. p. 894-902.
25. Vidal D, Barnadas M, Pérez M, Coll P, Alomar A. Tuberculous gumma following venepuncture. Br J Dermatol. 2001;144:601-3.
26. Wong HW, Tay YK, Sim CS. Papular eruption on a tattoo: a case of primary inoculation tuberculosis. Australas J Dermatol. 2005;46:84-7.
27. Davis M, Wright T, Shehan JM. A complication of mesotherapy: noninfectious granulomatous panniculitis. Arch Dermatol. 2008;144:808-9.
2. Camargo D, Saad C, Ruiz F, Ramírez ME, Lineros M, Rodríguez G, et al. Iatrogenic outbreak of M. chelonae skin abscesses. Epidemiol Infect. 1996;117:113-9.
3. Villanueva A, Villanueva R, Acosta B, Ruiz F, Agüero S, Zhang Y, et al. Report of an outbreak of postinjection abscesses due to Mycobacterium abscessus, including management with surgery and clarithromycin therapy and comparison of strains by random amplified polymorphic DNA polymerase chain reaction. Clin Infect Dis. 1997;24:147-53.
4. Prado AC, Castillo PF. Lay clinics and epidemic outbreak of mycobacterium skin and soft-tissue infection. Plast Reconstr Surg. 2004;113:800-1.
5. Del Solar M, Salomón M, Bravo F, Seas C, Gotuzzo E, Culqui D. Infección cutánea por micobacterias atípicas de crecimiento rápido (MACR) debido a mesoterapia cosmética. Reporte de casos y revisión de la literatura. Folia Dermatol Perú. 2005;16:127-35.
6. Rivera-Olivero IA, Guevar A, Escalona A, Oliver M, Pérez-Alfonzo R, Piquero J, et al. Infecciones en tejidos blandos por micobacterias no tuberculosas secundarias a mesoterapia. ¿Cuánto vale la belleza? Enferm Infecc Microbiol Clin. 2006;24: 302-6.
7. Sañudo A, Vallejo F, Sierra M, Hoyos JG, Yepes S, Wolf JC, et al. Nontuberculous mycobacteria infection after mesotherapy: preliminary report of 15 cases. Int J Dermatol. 2007;46:649-53.
8. Kent P, Kubica G. Public health mycobacteriology. A guide for the level III laboratory. Atlanta, Georgia: US Department Services, Centers for Disease Control; 1985.
9. Canneti G, Wallac FA, Khomenko A. Advances in techniques of testing mycobacterial drugs sensitivity and the use of sensitivity tests in tuberculosis control programs. Bull World Health Organ. 1969;41:21-43.
10. van Soolingen DV, De Hass PE, Kremer K. Restriction fragment length polymorphism (RFLP) typing of Mycobacteria. Bilthoven, The Netherlands: National Institute of Public Health and the Environment; 2002.
11. Burgos MV, Méndez JC, Ribón W. Molecular epidemiology of tuberculosis: methodology and applications. Biomédica 2004;24(Suppl.1):188-201.
12. Telenti A, Marchesi F, Balz M, Bally F, Bottger EC, Bodmer T. Rapid identification of Mycobacteria to the species level by polymerase chain reaction and restriction enzyme analysis. J Clin Microbiol. 1993;31:175-8.
13. Rodríguez G, Ortegón M, Camargo D, Orozco LC. Iatrogenic Mycobacterium abscessus infection: histopathology of 71 patients. Br J Dermatol. 1997;136:214-8.
14. Burman WJ, Reves RR. Review of false-positive cultures for Mycobacterium tuberculosis and recommendations for avoiding unnecessary treatment. Clin Infect Dis. 2000;31:1390-5.
15. Díaz BM, Muñoz OA, Klinger JC. Mycobacterium tuberculosis responsible for cutaneous disease after percutaneal inoculation of solutions: a case report. Int J Dermatol. 2003;42:564-6.
16. Ebrill D, Elek S. Tuberculous abscess following intramuscular penicillin. Lancet 1946;ii:379-80.
17. Tomar RP, Gupta A, Wilkhoo NS, Bhalla PJ. Tubercular abscess following intramuscular injections. Armed Forces Med J India. 2007;63:374-5.
18. de Jong JW, van Altena R. Non-respiratory tuberculosis with M. tuberculosis after penetrating lesions of the skin: five case histories. Int J Tuberc Lung Dis. 2000;12:1184-7.
19. Oka S, State M. 13 years follow up study of an epidemic inoculation tuberculosis in children caused by vaccination against Pertussis. Am Rev Resp Dis. 1963;88:462-5.
20. Genné D, Siegrist HH. Tuberculosis of the thumb following a needlestick injury. Clin Infect Dis. 1998;26:210-1.
21. Kramer F, Sasse SA, Simms JC, Leedom JM. Primary cutaneous tuberculosis after a needlestick injury from a patient with AIDS and undiagnosed tuberculosis. Ann Intern Med. 1993;119:594-5.
22. Oymak SF, Gülmez I, Demir R, Ozesmi M. Transmission of Mycobacterium tuberculosis by accidental needlestick. Respiration. 2000;67:696-7.
23. Barbagallo J, Tager P, Ingleton R, Hirsch R, Weinberg JM. Cutaneous tuberculosis. Diagnosis and treatment. Am J Clin Dermatol. 2002;3:319-28.
24. Grayson W, Calonge E, McKee P. Infectious diseases of the skin. Tuberculosis. In: McKee P, Calonge E, Granter SR, editors. Pathology of the skin with clinical correlation. Third edition. Philadelphia: Elsevier Mosby; 2005. p. 894-902.
25. Vidal D, Barnadas M, Pérez M, Coll P, Alomar A. Tuberculous gumma following venepuncture. Br J Dermatol. 2001;144:601-3.
26. Wong HW, Tay YK, Sim CS. Papular eruption on a tattoo: a case of primary inoculation tuberculosis. Australas J Dermatol. 2005;46:84-7.
27. Davis M, Wright T, Shehan JM. A complication of mesotherapy: noninfectious granulomatous panniculitis. Arch Dermatol. 2008;144:808-9.
How to Cite
1.
Orjuela D, Puerto G, Mejía G, Castro C, Garzón MC, García LM, et al. Cutaneous tuberculosis after mesotherapy: report of six cases. biomedica [Internet]. 2010 Sep. 30 [cited 2024 Jul. 22];30(3):321-6. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/264
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Published
2010-09-30
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Section
Case presentation
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