PMC9899797_01
Clinical images. Mycobacterium haemophilum infection after lipolysis injection at the initial visit (A) in the left shoulder, petechiae, and swelling (white arrows); (B) in the back, the area near the spine (not injected) also showed significant occupancy (black arrows); and (C) in the right shoulder. (D-F) Significant improvement in the patient's eruption can be observed after treatment.
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F1
Physical examination revealed multiple subcutaneous nodules and abscesses in the shoulders and upper back (Figures 1A, C). While several abscesses ruptured with minor pus exudate, a few continued to invade distant areas and formed new subcutaneous abscesses near the spine, distant from the injection's initial site (Figure 1B). After a year and a half, the patient's skin lesions gradually healed, only leaving scars (Figures 1D-F).
Skin ultrasound image findings. Ultrasonography of the skin lesions revealed multiple mixed cystic and solid areas on the back. Sinus tracts (A) opened to the body surface (white arrow), (B) spreading outward (white arrow), and (C) with a tendency to fuse between two occupancies (white arrow).
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F2
Internally, the sinus tracts were identical and connected to the body surface (Figure 2A). They even spread outward (Figure 2B), and in some places the pairs tend to fuse between each other (Figure 2C).
Histopathological findings. Skin lesion Hematoxylin and Eosin staining shows (A) epidermal hyperplasia and infectious granuloma into the dermis in certain areas; (B) infiltration of epithelioid cells, lymphocytes and other inflammatory cells; and (C) multinucleated giant cells (black arrow). Magnification: (A) x200; (B,C) x400.
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F3
Histopathological examination of the skin tissue specimen showed non-specific, diffuse inflammatory cell infiltration, suggestive of infectious granuloma (Figures 3A-C), but failed to reveal any special strains or organisms using Periodic acid-Schiff and acid-fast staining.
Mycobacterial strain identification. (A) Morphology of the skin lesion on Middlebrook 7H11 agar. (B) Acid-fast staining showed red and rod-shaped bacteria in branched filaments. Magnification: (B) x1000.
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F4
After 3 weeks of incubation, Middlebrook 7H11 agar exposed offwhite bacterial colonies (Figure 4A). Acid-fast staining revealed red and rod-shaped bacteria and branched filaments (Figure 4B).