Skip to main content

Advertisement

SpringerLink
Log in

Complicated Surgical Site Infection with Mycobacterium Abscessus After Liposuction and Affections of Corticosteroids in the Treatment Regimen: Three Cases Report and a Systematic Review

  • Review
  • Body Contouring
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Introduction

Mycobacterium abscessus infection after liposuction/fat grafting is a rare complication that is hard to diagnose and treat. Misdiagnosis could result in treatment failure and prolonged hospital stays. The paradoxical reaction is another complication that rarely occurs in non-HIV patients infected with nontuberculosis mycobacteria. This study reported 3 cases infected with M. abscessus complicated by the paradoxical reaction after liposuction and fat grafting. It highlighted characteristics giving clues of the paradoxical reaction and a successful strategy. Also, a systematic review was conducted to comprehensively provide varied aspects of M. abscessus infection after liposuction and/or fat grafting.

Methods

Three cases were retrospectively included reporting data characteristics of patients, cosmetic procedures, and treatment strategy. PubMed, Scopus, Virtual Health Library (VHL), and Global Health Library (GHL) were searched to find and include cases with M. abscessus infection after liposuction and/or fat grafting based on defined selection criteria. Relevant data were extracted and summarized. The risk of bias in included studies was assessed using JBI critical appraisal checklists.

Results

Twenty-four articles were included in the systematic review. Symptoms often developed approximately 1 month after the cosmetic surgery. Culture, AFB, and PCR were common methods of diagnosis of M. abscessus after liposuction and/or fat grafting. It took about 33 days on average from the presentation to isolate and detect the pathogens. Antibiotics based on susceptibility testing results along with surgical interventions were effective methods of treatment. Our three cases which were complicated by the paradox were addressed by adding methylprednisolone for 2 weeks to the macrolide-based therapy.

Conclusions

Awareness of this disease should be widely raised among physicians for early diagnosis and proper treatments. Cultures of specimens and AFB should be repeated many times before excluding the possibility of Mycobacterium spp. A paradoxical reaction should be suspected if the symptoms were worse after the antibiotic therapy based on susceptibility testing results and proper surgical interventions, especially if patients had taken corticosteroids before being admitted.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig 1
Fig 2.
Fig 3.
Fig 4

Similar content being viewed by others

References

  1. American Society of Plastic Surgeons. Plastic surgery statistic report 2020 Available from: https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-full-report-2020.pdf.

  2. Toledo LS (2006) Lipoplasty. Clin Plast Surg 33:xi–xii

    Article  Google Scholar 

  3. Shiffman MA, Di Giuseppe A (2006) Liposuction. Springer, Berlin

    Book  Google Scholar 

  4. Neira R, Ortiz-Neira C (2002) Low-level laser-assisted liposculpture: clinical report of 700 cases. Aesthetic Surg J 22:451–455

    Article  Google Scholar 

  5. Dixit VV, Wagh MS (2013) Unfavourable outcomes of liposuction and their management. Indian J Plastic Surg 46:377

    Article  Google Scholar 

  6. Kaoutzanis C, Gupta V, Winocour J, Layliev J, Ramirez R, Grotting JC et al (2017) Cosmetic liposuction: preoperative risk factors, major complication rates, and safety of combined procedures. Aesthetic Surg J 37:680–694

    Article  Google Scholar 

  7. Lehnhardt M, Homann HH, Daigeler A, Hauser J, Palka P, Steinau HU (2008) Major and lethal complications of liposuction: a review of 72 cases in Germany between 1998 and 2002. Plastic reconstructive surgery. 121:396e–403e

    Article  PubMed  Google Scholar 

  8. Torres-Coy J, Rodríguez-Castillo B, Pérez-Alfonzo R, De Waard J (2016) Source investigation of two outbreaks of skin and soft tissue infection by Mycobacterium abscessus subsp. abscessus in Venezuela. Epidemiol Infect 144:1117–1120

    Article  CAS  PubMed  Google Scholar 

  9. Lin S-S, Lee C-C, Jang T-N (2014) Soft tissue infection caused by rapid growing mycobacterium following medical procedures: two case reports and literature review. Ann Dermatol 26:236–240

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Cusumano LR, Tran V, Tlamsa A, Chung P, Grossberg R, Weston G et al (2017) Rapidly growing Mycobacterium infections after cosmetic surgery in medical tourists: the Bronx experience and a review of the literature. Int J Infect Dis 63:1–6

    Article  PubMed  Google Scholar 

  11. Tanaka T, Sekine A, Tsunoda Y, Takoi H, Lin S-Y, Yatagai Y et al (2015) Central nervous system manifestations of tuberculosis-associated immune reconstitution inflammatory syndrome during adalimumab therapy: a case report and review of the literature. Intern Med 54:847–851

    Article  CAS  PubMed  Google Scholar 

  12. Kobayashi M, Tsubata Y, Shiratsuki Y, Hotta T, Hamaguchi M, Isobe T (2022) Nontuberculous Mycobacterium-associated immune reconstitution inflammatory syndrome in a non-HIV immunosuppressed patient. Respirol Case Rep 10:e0918

    Article  PubMed  PubMed Central  Google Scholar 

  13. Friedman ND, McDonald AH, Robson ME, O’Brien DP (2012) Corticosteroid use for paradoxical reactions during antibiotic treatment for Mycobacterium ulcerans. PLos Neglected Tropical Dis 6(9):e1767

    Article  Google Scholar 

  14. Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, et al (2020) Chapter 7: Systematic reviews of etiology and risk. In Aromataris E, Munn Z (eds) JBI Manual for Evidence Synthesis. JBI

  15. Munn Z, Barker T, Moola S, Tufanaru C, Stern C, McArthur A et al (2020) Methodological quality of case series studies: an introduction to the JBI critical appraisal tool. JBI Evid Synth 18:2127–2133

    PubMed  Google Scholar 

  16. Newman MI, Camberos AE, Ascherman J (2005) Mycobacteria abscessus outbreak in US patients linked to offshore surgicenter. Ann Plast Surg 55:107–110

    Article  CAS  PubMed  Google Scholar 

  17. Hui SH, Noonan L, Chavada R (2015) Post liposuction Mycobacterium abscessus surgical site infection in a returned medical tourist complicated by a paradoxical reaction during treatment. Infect Dis Rep 7:6304

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lee RA, Wigmore R (2019) A case of lipotourism-associated multidrug-resistant Mycobacterium abscessus infection. J Global Infect Dis 11:83

    Article  Google Scholar 

  19. Motawea KR, Rabea RK, Elhalag RH, Goodloe J, Awad DM, Kaur M et al (2022) Cosmetic operative care abroad leads to a multidrug-resistant Mycobacterium abscessus infection in a patient: a case report. J Med Case Reports 16:1–5

    Article  Google Scholar 

  20. Cai SS, Chopra K, Lifchez SD (2016) Management of Mycobacterium abscessus infection after medical tourism in cosmetic surgery and a review of literature. Ann Plast Surg 77:678–682

    Article  CAS  PubMed  Google Scholar 

  21. Murillo J, Torres J, Bofill L, Ríos-Fabra A, Irausquin E, Istúriz R et al (2000) Skin and wound infection by rapidly growing mycobacteria: an unexpected complication of liposuction and liposculpture. Arch Dermatol 136:1347–1352

    Article  CAS  PubMed  Google Scholar 

  22. Furuya EY, Paez A, Srinivasan A, Cooksey R, Augenbraun M, Baron M et al (2008) Outbreak of Mycobacterium abscessus wound infections among “lipotourists” from the United States who underwent abdominoplasty in the Dominican Republic. Clin Infect Dis 46:1181–1188

    Article  PubMed  Google Scholar 

  23. Chang C-H, Chang Y-Y, Lu P-H (2018) Non-tuberculous mycobacteria infection following autologous fat grafting on the face. Aesthet Surg J 38:NP1–NP5

    Article  Google Scholar 

  24. Tung-Chen Y, Carballo-Cardona C (2017) Nontuberculous mycobacteria infection after aesthetic surgery. Med Clin 149:227–228

    Article  Google Scholar 

  25. Moreno-Izquierdo C, Zurita J, Contreras-Yametti F, Jara-Palacios M (2020) Mycobacterium abscessus subspecies abscessus infection associated with cosmetic surgical procedures: Case series. IDCases. 22:e00992

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Yang E, Hengshu Z (2021) Clinical analysis of nontuberculous mycobacterial infection after minimally invasive plastic surgery and cosmetic surgery. J Cosmet Dermatol 21(6):2523–2529

    Google Scholar 

  27. Yeh J-P, Tsai Y-J (2022) Nontuberculosis mycobacteria infection after liposuction and fat grafting for augmentation mammoplasty: a case report and literature review. Annals of Plastic Surg 10:1097

    Google Scholar 

  28. Tan L-C, Li X-Y, Lu Y-G (2020) Nontuberculous mycobacteria infection after autologous fat grafting for cosmetic breast augmentation. Ann Plast Surg 85:358–362

    Article  CAS  PubMed  Google Scholar 

  29. Escuredo IM, Elorduy EV, Carrión LG, Segura JE, Arcarazo PI, Gutiérrez JJG (2020) Mycobacterium abscessus infection after breast lipotransfer: a report of 2 cases. Plastic Reconstruct Surg Global Open 8:e3063

    Article  Google Scholar 

  30. Yang P, Lu Y, Liu T, Zhou Y, Guo Y, Zhu J et al (2017) Mycobacterium abscessus infection after facial injection with autologous fat: a case report. Ann Plast Surg 78:138–140

    Article  CAS  PubMed  Google Scholar 

  31. Galea L, Nicklin S (2009) Mycobacterium abscessus infection complicating hand rejuvenation with structural fat grafting. J Plastic, Reconstruct Aesthet Surg 62:e15–e16

    Article  CAS  Google Scholar 

  32. Chen B, Song H, Xu M, Gao Q, Wang F, Wang J et al (2020) Treatment for mycobacterium abscessus infection associated with fat grafting. Surg Infect 21:639–644

    Article  Google Scholar 

  33. Su C, Cowper SE, Ramachandran S, Little AJ (2020) Erythema nodosum due to Mycobacterium abscessusinfection complicating autologous fat transfer. Int J Women’s Dermatol 6:340–341

    Article  Google Scholar 

  34. Engdahl R, Cohen L, Pouch S, Rohde C (2014) Management of mycobacterium abscessus post abdominoplasty. Aesthet Plast Surg 38:1138–1142

    Article  CAS  Google Scholar 

  35. Ruegg E, Cheretakis A, Modarressi A, Harbarth S, Pittet-Cuénod B (2015) Multisite infection with mycobacterium abscessus after replacement of breast implants and gluteal lipofilling. Case Rep Infect Dis 2015:361340

    PubMed  PubMed Central  Google Scholar 

  36. Safe IP, Macedo V, Marcelo W, Baia-Da-Silva D, Freitas M, Spener R et al (2021) Nontuberculous mycobacterial infections after aesthetic procedures: comparison of clinical features and treatment. J Clin Aesthet Dermatol 14:46–49

    PubMed  PubMed Central  Google Scholar 

  37. Akers JO, Mascaro JR, Baker SM (2000) Mycobacterium abscessus infection after facelift surgery: a case report. J Oral Maxillofac Surg 58:572–574

    Article  CAS  PubMed  Google Scholar 

  38. Hill M, Weissman AS, Franzetti M, Allen P (2023) Novel, sensitivity-based antibiotic regimen for multidrug-resistant Mycobacterium abscessus infection following cosmetic surgery. JAAD Case Reports. 36:18–20

    Article  PubMed  PubMed Central  Google Scholar 

  39. Yoshimura K, Coleman SR (2015) Complications of fat grafting: how they occur and how to find, avoid, and treat them. Clin Plast Surg 42:383–388

    Article  PubMed  Google Scholar 

  40. Cuzalina A, Guerrero AV (2018) Complications in fat grafting. Atlas of the Oral Maxillofac Surg Clinics of North Am 26:77–80

    Article  Google Scholar 

  41. Neira R, Toledo L, Arroyave J, Solarte E, Isaza C, Gutierrez O et al (2006) Low-level laser-assisted liposuction: the Neira 4 L technique. Clin Plast Surg 33:117–127

    Article  PubMed  Google Scholar 

  42. Chang PY, Wu TL, Tsao KC, Sun CF, Wu LL, Wu JT (2007) Cosmetic liposuction causes only transient elevation of acute inflammatory response and does not advance to oxidative and nitrosative stress. J Clin Lab Anal 21:418–425

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Hong YG, Kim HT, Seo SW, Chang CH, Rhee EJ, Lee WY (2006) Impact of large-volume liposuction on serum lipids in orientals: a pilot study. Aesthetic Plast Surg 30:327–332

    Article  PubMed  Google Scholar 

  44. Gibas-Dorna M, Szulińska M, Turkowski P, Kupsz J, Sowińska A, Mikrut K et al (2017) The effect of VASER abdominal liposuction on metabolic profile in overweight males. Am J Mens Health 11:284–293

    Article  PubMed  Google Scholar 

  45. Esposito K, Giugliano G, Giugliano D (2004) Metabolic effects of liposuction—yes or no. N Engl J Med 351:1354–1357

    Article  CAS  PubMed  Google Scholar 

  46. Chen L, Deng H, Cui H, Fang J, Zuo Z, Deng J et al (2018) Inflammatory responses and inflammation-associated diseases in organs. Oncotarget 9:7204

    Article  PubMed  Google Scholar 

  47. Jovanović Z, Ilić M, Janković S (2007) Pathogenic mechanisms in the development of surgical site infections. Med Pregl 60:343–350

    Article  PubMed  Google Scholar 

  48. Novosad SA, Beekmann SE, Polgreen PM, Mackey K, Winthrop KL (2016) Treatment of Mycobacterium abscessus infection. Emerg Infect Dis 22:511

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Murthy AR, Marulappa R, Hegde U, Kappadi D, Ambikathanaya U, Nair P (2015) Treatment guidelines and prognosis of immune reconstitution inflammatory syndrome patients: a review. J Int Oral Health: JIOH. 7:92

    PubMed  PubMed Central  Google Scholar 

  50. O’Brien DP, Robson ME, Callan PP, McDonald AH (2009) “Paradoxical” immune-mediated reactions to Mycobacterium ulcerans during antibiotic treatment: a result of treatment success, not failure. Med J Aust 191:564–566

    Article  PubMed  Google Scholar 

  51. Tükenmez H, Edström I, Kalsum S, Braian C, Ummanni R, Fick SB et al (2019) Corticosteroids protect infected cells against mycobacterial killing in vitro. Biochem Biophys Res Commun 511:117–121

    Article  PubMed  Google Scholar 

  52. Gräb J, Suárez I, van Gumpel E, Winter S, Schreiber F, Esser A et al (2019) Corticosteroids inhibit Mycobacterium tuberculosis-induced necrotic host cell death by abrogating mitochondrial membrane permeability transition. Nat Commun 10:688

    Article  PubMed  PubMed Central  Google Scholar 

  53. Fujita J (2020) Immune reconstitution inflammatory syndrome in the lung in non-human immunodeficiency virus patients. Respir Investig 58:36–44

    Article  PubMed  Google Scholar 

  54. Maurer F, Castelberg C, Von Braun A, Wolfensberger A, Bloemberg G, Böttger E et al (2014) Postsurgical wound infections due to rapidly growing mycobacteria in Swiss medical tourists following cosmetic surgery in Latin America between 2012 and 2014. Eurosurveillance 19:20905

    Article  PubMed  Google Scholar 

  55. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR et al (2017) Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 152:784–791

    Article  PubMed  Google Scholar 

  56. World Health Organization (2016) Global guidelines for the prevention of surgical site infection. World Health Organization

  57. Lee Y-H, Kim H-K, Kim M-S, You H-J, Kim D-W, Lee T-Y (2022) Chemical sterilization of lipoplasty cannula and nontuberculous mycobacteria disinfection: an experimental study. J Craniofacial Surg 33:719–722

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Hoang Tuan Clinic, Hoang Quoc Viet, Hanoi, Vietnam

    Hoang Thanh Tuan, Nguyen Anh Ngoc, Luu Dang Ai & Nguyen Van Luat

Authors
  1. Hoang Thanh Tuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nguyen Anh Ngoc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luu Dang Ai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nguyen Van Luat
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hoang Thanh Tuan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

The patient gave consent for the publication.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tuan, H.T., Ngoc, N.A., Ai, L.D. et al. Complicated Surgical Site Infection with Mycobacterium Abscessus After Liposuction and Affections of Corticosteroids in the Treatment Regimen: Three Cases Report and a Systematic Review. Aesth Plast Surg 48, 1365–1385 (2024). https://doi.org/10.1007/s00266-023-03512-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-023-03512-x

Keywords

Search

Navigation