Abscesses due to Mycobacterium abscessus linked to injection of unapprovedalternative medication

An unlicensed injectable medicine sold as adrenal cortex extract (ACE*) and distributed in the alternative medicine community led to the largest outbr eak of Mycobacterium abscessus infections reported in the United States. Re cords from the implicated distributor from January 1, 1995, to August 18, 1 996, were used to identify purchasers; purchasers and public health alerts were used to identify patients. Purchasers and patients were interviewed, a nd available medical records were reviewed. Vials of ACE* were tested for m ycobacterial contamination, and the product Was recalled by the U.S. Food a nd Drug Administration. ACE* had been distributed to 148 purchasers in 30 s tates; 87 persons with postinjection abscesses attributable to the product were identified. Patient and vial cultures contained M. abscessus identical by enzymatic and molecular typing methods. Unusual infectious agents and a lternative health practices should be considered in the diagnosis of infect ions that do not respond to routine treatment.