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Guidance on the treatment of rare deep subcutaneous mycobacterium abscess following cosmetic procedures: a case series and systematic review of the literature

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Mycobacterium abscessus (MA) is a drug-resistant non-tuberculous mycobacterium associated with subcutaneous infections post-cosmetic surgery. It is difficult to diagnose and manage. Case reports of MA following cosmetic procedures have been reported within Asia and South America, but not the UK. Here we report a case series of three patients with a diagnosis of MA infection following a cosmetic procedure performed either abroad or within the UK. We describe their management and perform a review of the literature.

Methodology

Patients who had developed MA infections following cosmetic procedures presenting to and treated at a single institute were reviewed. A retrospective review of the patients’ records was performed. A systematic review of the literature was performed adhering to PRISMA guidelines.

Results

Three patients were identified. None was immunocompromised. All were treated with long-term antibiotics, with 2/3 patients requiring repeated surgical debridement. Systematic review of the literature highlighted 25 articles reported between 2000 and 2022. Seventy-seven patients were treated. The most common antibiotics used were clarithromycin (51.9%, n = 40), amikacin (45.5%, n = 35) and imipenem (18.2%, n = 14).

Conclusion

A low index of suspicion for MA infection should be placed in patients who develop subcutaneous lesions post-cosmetic procedures. Infection is associated with a poor response to routine antimicrobials and negative bacterial cultures. Successful management requires a multi-disciplinary approach with input from the Infectious Diseases, Plastic Surgery and Radiological teams. With the rise in cosmetic surgery tourism, early recognition of MA is pertinent to reduce morbidity and healthcare burden from this rare but debilitating complication.

Level of evidence: Level V, Therapeutic/Diagnostic.

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Acknowledgements

We would like to thank the patient for consenting for having their case published as a learning case. We would like to thank Dr Aisling Brown and Dr Anna Goodman, consultants in Infectious Diseases at Guys and St Thomas’ NHS trust for providing us with guidance with the patients ongoing NTM therapy and recommendations for the management of MA-related subcutaneous infections. We would also like to thank Dr Steve Connor consultant radiologist at Guys and St Thomas’ NHS Trust for providing the necessary radiological images for this report

Funding

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Authors and Affiliations

  1. Department of Plastic & Reconstructive Surgery, St Thomas’ Hospital, London, UK

    Umar Rehman, Pennylouise Hever, Inez Eiben & Jenny Geh

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  1. Umar Rehman
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  2. Pennylouise Hever
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  3. Inez Eiben
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Correspondence to Umar Rehman.

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Conflict of interest

Umar Rehman, Pennylouise Hever, Inez Eiben and Jenny Geh declare no conflict of interest.

Ethical approval

The National Health Service Research Ethics Committee (NHS-REC) tool was used to determine whether ethical approval was required for this study. According to the results of the tool ethical approval was not required to conduct the study.

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All necessary consent was obtained from patients where images were included and patient details were anonymised.

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Rehman, U., Hever, P., Eiben, I. et al. Guidance on the treatment of rare deep subcutaneous mycobacterium abscess following cosmetic procedures: a case series and systematic review of the literature. Eur J Plast Surg 46, 625–635 (2023). https://doi.org/10.1007/s00238-023-02053-5

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  • DOI: https://doi.org/10.1007/s00238-023-02053-5

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