Recurrent bilateral breast abscess due to Mycobacterium abscessus in an immune-competent woman

BMJ Case Rep. 2020 Oct 30;13(10):e235857. doi: 10.1136/bcr-2020-235857.

Abstract

Mycobacterium abscessus is a rapidly growing, non-tubercular mycobacteria, often associated with skin and soft tissue infections. We report a case of 57-year-old immune-competent woman who suffered recurrent bilateral breast infection for 6 years. She did not benefit from repeated surgical interventions and multiple courses of antibiotics, and one course of empirical antitubercular therapy. Chronicity of the presentation and non-response to varied treatment interventions prompted further microbiological investigations. The patient was diagnosed with M. abscessus and treated with rifabutin, clarithromycin daily for 6 months and injection amikacin for 1 month. Amikacin was replaced with oral levofloxacin due to bilateral sensory-neural hearing loss for higher frequencies after 6 months. Suspicion and identification of NTM are important as the treatment involves long-term combination antibacterial therapy along with surgical debridement for extensive infection or when implants are involved.

Keywords: TB and other respiratory infections; breast cancer; breast surgery; infectious diseases.

Publication types

  • Case Reports

MeSH terms

  • Abscess / diagnosis
  • Abscess / drug therapy
  • Abscess / microbiology*
  • Anti-Bacterial Agents / therapeutic use
  • Antitubercular Agents / therapeutic use
  • Biopsy
  • Breast / diagnostic imaging
  • Breast / microbiology*
  • Female
  • Humans
  • Immunocompromised Host*
  • Magnetic Resonance Imaging
  • Middle Aged
  • Mycobacterium Infections, Nontuberculous / diagnosis
  • Mycobacterium Infections, Nontuberculous / drug therapy
  • Mycobacterium Infections, Nontuberculous / microbiology*
  • Mycobacterium abscessus / isolation & purification*
  • Recurrence

Substances

  • Anti-Bacterial Agents
  • Antitubercular Agents