Mycobacterium kansasii skin infection at insulin injection sites.

Background. Insulin injection sites rarely become infected. We report a c;i se of Mycobacterium kansasii infection at the sites of insulin injection. Case report. An 84-year-old woman with insulin dependent diabetes consulted for lesions on the anterior aspect of the thighs. She had papulonodules at the sites of insulin injection. These lesions progressed to hard fibrinone crotic ulcerations with a raised erythematous border. There were no enlarge d nodes locally. Laboratory tests were normal. Bacteriological samples were negative at direct examination. Histology was not specific The biopsy cult ures finally found an atypical mycobacteria, Mycobacterium kansasii. The cl inical course was favorable with clarithromycin alone. Discussion. Only 35 cases of Mycobacterium kansasii skin infections have be en reported in the literature. This is the first case observed in a diabeti c subject and the first treated with clarithromycin alone. This case illust rates the potential, though exceptional, risk of insulin bottle contaminati on by an environmental germ.