Nontuberculous mycobacteria (NTM), especially rapidly growing species such as Mycobacterium abscessus , have emerged as agents of cutaneous infections associated with minimally invasive aesthetic procedures. These infections are difficult to manage due to intrinsic resistance to several antimicrobials, biofilm formation, and intracellular persistence. A 44-year-old previously healthy woman sought medical care for inflammatory ulcerated lesions on the right thigh, characterized by erythema, pain, increased local heat, and serous discharge, a few days after an aesthetic procedure involving injections of lipolytic enzymes into the gluteal and thigh regions. She was initially treated empirically with cefadroxil, but lesions disseminated to the abdomen and left thigh, leading to a change in outpatient therapy to sulfamethoxazole–trimethoprim. Subsequently, she also received courses of linezolid, clindamycin, and doxycycline, without clinical improvement. Two months after empirical treatments, she was hospitalized for debridement and culture collection. Culture of the collected secretion grew Mycobacterium abscessus subsp. bolletii , harboring a mutation in the erm(41) gene. Guided by susceptibility testing, six months of treatment with intravenous amikacin and tigecycline was instituted, resulting in complete clinical resolution. This case illustrates a cutaneous infection caused by a rapidly growing mycobacterium associated with aesthetic application of lipolytic enzymes, highlighting the risk of NTM infection in minimally invasive procedures performed without strict aseptic control. Early diagnosis, microbiological identification with susceptibility testing, and prolonged clinical follow-up are essential due to the recurrent and refractory potential of these infections.
Silva et al. (2026) studied this question.