![]() ![]() ![]() fortuitum complex were ordered at the National Jewish Health Laboratory in Denver. She was started on empiric intravenous (IV) antibiotics (meropenem and amikacin) and moxifloxacin. The wounds were then dressed using Iodoform gauze and ABD pads and secured with a Tegaderm with Mastisol used to keep the Tegaderm in place. Each wound was opened further and the wound cavity was cleaned by pulse irrigation. It was yellow, thick, and creamy, and a culture swab was taken of this for aerobic and anaerobic infection. Incision was followed by immediate egress of pus under pressure. Each abscess was incised at the pointed area with maximal threat of tissue breakdown. She underwent incision and drainage and surgical debridement of the abdominal wall abscesses. A repeat CT abdomen and pelvis revealed significant resolution of the anterior abdominal wall fluid collection and subcutaneous rim-enhancing collection in the left flank suggestive of developing abscesses along with multiple other developing abscesses ( Figure 4). Two weeks later, she returned with two new soft tender swellings in her left lateral hip ( Figure 2) and low mid back ( Figure 3). Patient was started on oral levofloxacin and doxycycline and discharged home with outpatient follow-up.ĬT abdomen and pelvis with intravenous contrast showing large subcutaneous collection in the anterior abdominal wall (blue arrow) suggestive of abscess. After 16 s rRNA sequencing analysis, the isolate was identified as Mycobacterium fortuitum complex. Samples were sent to Yale New Haven Hospital Laboratory for further identification. Ziehl-Neelsen stain was positive and rapid growth was detected in the AFB culture media. During the procedure a sample of cloudy, straw colored fluid was sent for aerobic, anaerobic, and acid-fast bacilli (AFB) cultures. Patient underwent CT guided drainage with placement of a drain in the anterior abdominal wall. It also showed multiple areas of increased attenuation over the subcutaneous tissues of the abdomen, lower back, and bilateral flanks. Computed Tomography (CT) of the abdomen and pelvis with contrast noted a large subcutaneous collection in the anterior abdominal wall suggestive of abdominal wall seroma ( Figure 1). Comprehensive metabolic panel was within normal limits. Both Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) were elevated at 33 mm/hr and 2.3 mg/dL, respectively. Complete blood count revealed a hemoglobin of 9.1 g/dl and white blood cell count of 13.7 × 10 9 per liter (L) with 73% neutrophils. Physical examination revealed an erythematous tender indurated area in the epigastrium approximately 2 cm in diameter. Her body temperature was 36.8☌ and she saturated 98% in room air. ![]() On arrival to the Emergency Department, her vitals were stable with blood pressure of 99/65 mm Hg, pulse rate of 100 beats per minute, and respiratory rate of 20 per minute. She also denied recent illness, sick contacts, or exposures. Pertinent negative history included absence of nausea, vomiting, diarrhea, fever, chills, chest pain, shortness of breath, or changes in bowel habits. She developed abdominal discomfort a few days after she left the hospital and this progressed slowly over the weeks. Our case highlights the fact that identification of these organisms can be difficult requiring referral of samples to specialized laboratories and treatment duration can last several months, which is determined by clinical and microbiological response.Ī 34-year-old female with past medical history significant for abdominoplasty in Dominican Republic three weeks prior to presentation came to our hospital with complaints of redness and swelling in the epigastric region. This case is of interest as more than one species of RGM was isolated from the same patient. In the absence of clear treatment guidelines, she was treated with a combination of intermittent surgical drainage and prolonged antibiotic course. ![]() We present a case of a 34-year-old female who underwent abdominoplasty in Dominican Republic that was complicated with development of multiple abdominal wall abscesses due to infection from rapidly growing mycobacteria (RGM). Many cases of infections have been documented in patients following cosmetic surgeries in developing countries. There is a paucity of data on quality, safety, and risks involved with these surgeries. Lipotourism is a form of medical tourism becoming popular among patients of developed countries due to the cost efficiency of cosmetic procedures when performed in developing nations. Increasing number of medical tourists travel internationally for cosmetic procedures. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |