Diagnosis and treatment of non-tuberculous mycobacterial (NTM) infections represent a challenge in infectious disease practice. These infections may occur in different settings and are increasingly associated with cosmetic procedures. This study aims to report an infection associated with facial hyaluronic acid implantation in Salvador, Bahia. A 47-year-old woman with no previous comorbidities underwent hyaluronic acid filler injection two years earlier and developed a persistent periorbital swelling below the left eye. After sleeping with false eyelashes, she developed irritation and inflammation in the same eye and sought dermatological consultation. Culture of ocular secretion with pus and blood was collected. She had no fever or chills. AFB test was positive, TRM-TB was not detected, and aerobic bacterial culture was negative. Mycobacterial culture was positive for Mycobacterium fortuitum , with the following susceptibility profile: sensitive to amikacin, tigecycline, doxycycline, ciprofloxacin, linezolid, moxifloxacin, imipenem, cefoxitin, and sulfamethoxazole–trimethoprim, and resistant to clarithromycin. The patient was treated with linezolid 600 mg/day, moxifloxacin 400 mg/day, and sulfamethoxazole–trimethoprim (800+160 mg) every 12 hours. After three months, follow-up showed resolution of the infectious process, and treatment was maintained for one year. Infections caused by Mycobacterium fortuitum present nonspecific manifestations and scarcity of systemic symptoms, delaying diagnosis. Intrinsic resistance to several antibiotics and the need for prolonged treatment require an individualized approach guided by susceptibility testing. This report highlights the importance of clinical suspicion and microbiological testing. A multidisciplinary approach ensures appropriate management of these complex infections.
Bahia et al. (2026) studied this question.