Piercing-Related Nontuberculous Mycobacterial Infection
The present case has been reported in NEJM. An 18-year-old woman with the long-QT syndrome was referred to dermatology clinic with a large, fluctuant, violaceous plaque on her right cheek (Panel A). Her right tragus had been professionally pierced 6 months earlier, and streaking had developed along the angle of her jaw 1 month after the piercing.

Her primary care physician drained an abscess in the region and prescribed cephalexin, but the condition did not improve. On further evaluation, an atypical infectious cause was considered, and a biopsy was performed; the specimen showed granulomatous inflammation but no acid-fast bacilli.

The tissue culture grew Mycobacterium fortuitum. Four months of treatment with ciprofloxacin and trimethoprim–sulfamethoxazole resulted in clinical improvement at follow-up (Panel B). A macrolide was not administered, owing to the use of a beta-blocker.

Various cutaneous presentations, including pustules, plaques, and ulcers, can be due to infection with nontuberculous mycobacterium. This should be considered when piercing-related infections fail to respond to antibiotics that are effective against common bacterial pathogens. Acid-fast bacilli are not always detectable on staining; definitive diagnosis depends on isolation of the organism on tissue culture.

Read in detail here: https://www.nejm.org/doi/full/10.1056/NEJMicm0906854
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