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LETTER TO EDITOR
Year : 2011  |  Volume : 28  |  Issue : 4  |  Page : 320-321  

Mycobacteria in keloid


1 Department of Dermatology, Venereology, Leprology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
2 Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India

Date of Web Publication7-Oct-2011

Correspondence Address:
S Ambujam
Department of Dermatology, Venereology, Leprology, Mahatma Gandhi Medical College and Research Institute, Pondicherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-2113.85749

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How to cite this article:
Singh A, Ambujam S, Kumar S, Devi S U. Mycobacteria in keloid. Lung India 2011;28:320-1

How to cite this URL:
Singh A, Ambujam S, Kumar S, Devi S U. Mycobacteria in keloid. Lung India [serial online] 2011 [cited 2019 Nov 14];28:320-1. Available from: http://www.lungindia.com/text.asp?2011/28/4/320/85749

Sir,

Mycobacterium continues to haunt human beings in its different forms. Studies have shown that skin tuberculosis accounts for 0.025% of all patients with tuberculosis and nearly 15% of patients with extrapulmonary tuberculosis. [1] Incidence of nontuberculous mycobacterial infection has increased in the past two decades, especially in immunocompromised hosts. [2] Skin involvement of Mycobacterium has always been known for its varied clinical presentation, with many of them diagnosed years after the onset of symptoms. We came across one such uncommon clinical presentation.

A 60-year-old man was referred to us with complaint of painless ulcer of 2 years duration. The ulcer was over a keloid in the presternal area [Figure 1]. The patient gave a history of having been treated with two intralesional steroid (Triamcinolone) injections for the keloid, 2 weeks apart. Two weeks following the second injection of Triamcinolone, the patient developed a papule which ulcerated later on. The ulcer was not healing completely even after antibiotic therapy. Examination revealed the presence of multiple keloids over chest, with one over presternal area showing an ulcer (size nearly 1.5 × 1.5 × 1.5 cm), with erythematous base and undermined edges. Pus from the ulcer was sent for microbiological examination. Gram staining showed the presence of multiple pus cells with no bacteria. Culture was also found to be sterile. Based on these findings, mycobacteria were suspected to be the cause for the non-healing ulcer. Zeihl Neelsen staining was done which showed the presence of acid-fast bacilli [Figure 2]. But culture and polymerase chain reaction (PCR) were negative for Mycobacterium tuberculosis. Thus, a diagnosis of mycobacterial infection in keloid was made. Species detection was not possible due to limited resources. Treatment was started with a combination of Amikacin and Clarithromycin. Patient was regularly followed up. Lesions healed completely in 4 months. We presume that bacilli were introduced into the keloid along with the steroid injection, which also reduced the local immunity.
Figure 1: Keloid with ulcer

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Figure 2: Mycobacteria detected on staining

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Infection with rapidly growing nontuberculous mycobacterial infection may follow injection with contaminated needles. The infection may follow cosmetic surgery breast implantation. Post surgical infection presents with painful nodule, ulcer, abscess, sinus tract or cellulitis. [3]

Steroids can cause a decrease in local immunity following injections. [4] Thus, they predispose to infection with bacteria following injections with improper antisepsis of skin, unsterilized syringe or contaminated steroid vial. [4]

Some skin lesions may occur at the site of trauma, including those developing at the site of invasive diagnostic and therapeutic procedures. If they follow a chronic course and do not respond to antibiotics, a mycobacterial etiology should be considered.

 
   References Top

1.Ramam M. Cutaneous Tuberculosis. In: Sharma SK, Mohan A, editors, 2 nd ed. New Delhi, India: Jaypee Brothers Medical Publishers (P) LTD; 2009. p. 384-96.  Back to cited text no. 1
    
2.Blackwell V. Mycobacterium marinum infections. Curr Opin Infect Dis 1999;12:181-4.  Back to cited text no. 2
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3.Aldabagh BA, Tomecki KJ. Cutaneous nontuberculous mycobacterial infections. Dermatol Nurs 2009;21:179-82, 189.  Back to cited text no. 3
[PUBMED]    
4.Saigal G, Donovan Post MJ, Kozic D. Thoracic intradural aspergillus abscess formation following epidural steroid injection. AJNR Am J Neuroradiol 2004;25:642-4.  Back to cited text no. 4
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    Figures

  [Figure 1], [Figure 2]



 

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