Cutaneous infection with Mycobacterium fortuitum after localized microinjections (mesotherapy) treated successfully with a triple drug regimen

Mesotherapy is a treatment method devised for controlling pain syndromes or diseases by subcutaneous microinjections given at or around the involved a reas at short intervals of time. Different adverse effects have been descri bed due to this modality of treatment. This report describes 3 patients wit h cutaneous infection caused by Mycobacterium fortuitum after mesotherapy. Three women, aged 24, 27 and 44 years, presented with similar clinical feat ures, consisting of painful nodules located at the points where mesotherapy had been applied. A smear from a skin biopsy revealed the presence of acid -fast bacilli in all 3 cases. The specimen was cultured and eventually iden tified as M. fortuitum. A multidrug long-term regimen (combinations of 3 dr ugs from the following: ciprofloxacin, cotrimoxazole, clarithromycin and am oxicillin-clavulanic acid) was needed to achieve resolution of the lesions. After 15, 25 and 26 months of follow-up, no patient relapsed. Mycobacteriu m fortuitum is a rapidly growing mycobacterium that can lead to cutaneous i nfection after minor surgical procedures when aseptic measures are not adeq uate. Multiple drugs for several months are usually needed to treat this di sease successfully.