A Diabetic Woman with Insulin Injection Abscesses
A 50-year-old diabetic woman developed multiple abscesses after daily injections of subcutaneous regular human insulin. Initial cultures from the draining fluid revealed no organisms, and the patient was unresponsive to multiple courses of antibiotics including doxycycline, amoxicillin/clavulanic acid, and intravenous vancomycin and piperacillin/tazobactam. After consulting dermatology, the patient underwent punch biopsy and tissue culture. The tissue culture grew mycobacterium fortuitum after 22 days of incubation. The patient was diagnosed with non-tuberculous mycobacterial infection and began to improve after treatment with ciprofloxacin. Non-tuberculous mycobacteria are common in the environment, although systemic manifestations of infection are rare in healthy individuals. In this paper, we discuss the risk factors, diagnostic methods, and treatment recommendations for these types of infections.
Kothavade, R.J., et al., Clinical and laboratory aspects of the diagnosis and management of cutaneous and subcutaneous infections caused by rapidly growing mycobacteria. Eur J Clin Microbiol Infect Dis, 2013. 32(2): p. 161-88.
Bates, T.R., et al., Extensive cutaneous Mycobacterium abscessus infection due to contaminated insulin delivery system. QJM, 2009. 102(12): p. 881-4.
Domergue Than Trong, E., et al., [Mycobacterium kansasii skin infection at insulin injection sites]. Ann Dermatol Venereol, 2001. 128(3 Pt 1): p. 250-2.
Jackson, P.G., et al., Injection abscesses due to mycobacterium chelonei occurring in a diabetic patient. Tubercle, 1981. 62(4): p. 277-9.
Pagnoux, C., et al., Infection of continuous subcutaneous insulin infusion site with Mycobacterium peregrinum. Diabetes Care, 1998. 21(1): p. 191-2.
Shibayama, Y., et al., A case of Mycobacterium abscessus infection presenting as a cystic lesion in an insulin injection site in a diabetic patient. J Dermatol, 2014. 41(5): p. 469-70.
Uslan, D.Z., et al., Skin and soft tissue infections due to rapidly growing mycobacteria: comparison of clinical features, treatment, and susceptibility. Arch Dermatol, 2006. 142(10): p. 1287-92.
Shrestha, N.K., et al., Detection and differentiation of Mycobacterium tuberculosis and nontuberculous mycobacterial isolates by real-time PCR. J Clin Microbiol, 2003. 41(11): p. 5121-6.
Kasperbauer, S.H. and M.A. De Groote, The treatment of rapidly growing mycobacterial infections. Clin Chest Med, 2015. 36(1): p. 67-78.
McCarthy, J.A., B. Covarrubias, and P. Sink, Is the traditional alcohol wipe necessary before an insulin injection? Dogma disputed. Diabetes Care, 1993. 16(1): p. 402.
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