Cutaneous Nontuberculous Mycobacteria Infection after Cosmetic Tattooing: A Case Report

Main Article Content

Jennifer Seyffert
Christopher Wong
Sadia Saeed
David Fitzmaurice

Keywords

Nontuberculous mycobacteria, atypical mycobacterial, cutaneous infection, tattoo infection, Mycobacterium chelonae

Abstract

Nontuberculous (atypical) mycobacteria rarely cause skin and soft tissue infections. Tattooing with contaminated gray ink has been implicated in previously reported outbreaks. We report the case of a 39-year-old Hispanic male who presented with a refractory, pruritic, papular eruption within the distribution of his tattoo with punch biopsy demonstrating papillary dermal granulomatous and suppurative inflammation surrounding small collections of acid-fast bacilli with associated superficial and deep dermal perivascular lymphatic inflammation, consistent with nontuberculous mycobacterial infection. Although uncommon, clinicians should consider nontuberculous mycobacterial infection in the differential diagnosis of refractory tattoo-associated skin eruptions.

References

1. Chung J, Ince D, Ford BA, Wanat KA. Cutaneous Infections Due to Nontuberculosis Mycobacterium: Recognition and Management. Am J Clin Dermatol. 2018;19(6):867-878. doi:10.1007/s40257-018-0382-5

2. Misch EA, Saddler C, Davis JM. Skin and Soft Tissue Infections Due to Nontuberculous Mycobacteria. Curr Infect Dis Rep. 2018;20(4):6. doi:10.1007/s11908-018-0611-3

3. Donohue MJ, Mistry JH, Donohue JM, et al. Increased Frequency of Nontuberculous Mycobacteria Detection at Potable Water Taps within the United States. Environ Sci Technol. 2015;49(10):6127-6133. doi:10.1021/acs.est.5b00496

4. Mudedla S, Avendano EE, Raman G. Non-tuberculous mycobacterium skin infections after tattooing in healthy individuals: A systematic review of case reports. Dermatol Online J. 2015;21(6).

5. Bounniyt H, Guth-Muller S, Zimmermann U, Blom A, Saiag P. Une complication rare d’un tatouage permanent. Presse Médicale. 2018;47(1):94-95. doi:10.1016/j.lpm.2017.10.013

6. Griffin I, Schmitz A, Oliver C, et al. Outbreak of Tattoo-associated Nontuberculous Mycobacterial Skin Infections. Clin Infect Dis. November 2018. doi:10.1093/cid/ciy979

7. Frew JW, Nguyen RT. Tattoo-associated mycobacterial infections: an emerging public health issue. Med J Aust. 2015;203(5):223. doi:10.5694/mja15.00098

8. Brooks J, Behrens E, Prickett K. Painful and Pruritic Papules in the Gray Shading of a Tattoo. JAMA Dermatol. 2016;152(2):205. doi:10.1001/jamadermatol.2015.3448

9. Painsi C, Lange-Asschenfeldt B. Image Gallery: Pink papules within a tattoo linked to Mycobacterium chelonae infection. Br J Dermatol. 2017;177(1):e1-e1. doi:10.1111/bjd.15481

10. Velez L, Harb J, Anuszewski S, Wesson S. Cutaneous Mycobacterium massiliense infection from tattooing: a common yet under-reported and persistent epidemic hazard for dermatologists. BMJ Case Rep. January 2018:bcr-2017-222762. doi:10.1136/bcr-2017-222762

11. Bhargava A, Chandrasekar PH. Gradually Worsening Tattoo Lesion. JAMA. 2015;314(19):2071. doi:10.1001/jama.2015.10066

12. Griffith DE, Aksamit T, Brown-Elliott BA, et al. An Official ATS/IDSA Statement: Diagnosis, Treatment, and Prevention of Nontuberculous Mycobacterial Diseases. Am J Respir Crit Care Med. 2007;175(4):367-416. doi:10.1164/rccm.200604-571ST