Giant Mycobacterium fortuitum Abscess Associated With Systemic Lupus Erythematosus

A 36-year-old woman with a 1 1/2-year history of systemic lupus erythematosus was first seen in October 1984 with a six-month history of several ulcerated and scarred lesions on the lower extremities. A biopsy specimen showed a granulomatous infiltrate of deep dermis and subcutaneous tissue. Over the next three weeks, the patient developed a violaceous, warm, indurated, tender, fluctuant lesion involving most of the left buttock. A culture showed a rapidly growing atypical acid-fast bacteria, which was later identified as Mycobacterium fortuitum. The patient was treated with surgical drainage of the left hip abscess, followed by a three-week treatment with doxycycline hyclate and amikacin sulfate. She was discharged while receiving oral doxycycline and ethambutol hydrochloride.