Nontuberculous mycobacterial infections of the lower extremities: A 15-year experience.

OBJECTIVES: Nontuberculous mycobacterial infection (NTMI), which is increasing in prevalence, is challenging to diagnose and manage despite the availability of capable laboratories because of subtle and nonspecific clinical findings and nonstandardized treatment guidelines. We aimed to present our experience with lower-extremity NTMI and to compare clinical characteristics and treatment outcomes between immunocompetent and immunocompromised patients. METHODS: To determine clinical presentations and outcomes, we reviewed electronic health records of all patients with lower-extremity NTMI treated and followed up at our institution from January 2002 through December 2017. RESULTS: Twenty-four patients were included in this study. Mean (SD) age was 58 (19) years. Eighteen patients (75%) were men; 13 (54%) were immunocompetent; and 9 (37%) had bone and joint involvement. No significant differences existed between immunocompetent and immunocompromised patients, except immunocompetent patients had significantly more infections at the hip, thigh, and toe. Bone and joint infection required significantly longer treatment time than skin and soft-tissue infection. CONCLUSIONS: Regardless of immune status, patients with lower-extremity NTMI had similar characteristics, treatments, and outcomes. However, immunosuppression can be a major risk factor in the development of disseminated NTMI and associated complications. Acid-fast bacilli culture is strongly recommended for evaluation of delayed or nonhealing lesions. Aggressive medical and surgical management can be associated with good clinical outcomes.

Case report: Endometrioma of the abdominal wall.

We present the case of a 39-year-old woman with a 2- to 3-month history of a soft tissue mass involving the abdominal wall and increasing symptoms that fluctuated relative to her menses. Magnetic resonance imaging showed a hemorrhagic multiloculated mass within the rectus abdominus muscle. Correlation of the clinical history and imaging finding suggested a preoperative diagnosis of endometrioma of the abdominal wall. This was confirmed on histologic analysis of the resected specimen.