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Masquerading Mycobacterium: Plastic Surgeon to the Rescue

A patient with a Mycobacterium marinum infection of the hand is described. The present case illustrates that M marinum infection may mimic common skin conditions such as eczema, and fungal and parasitic infestations. Key elements in the diagnosis and management of this infection are a high index of suspicion, a detailed history of recreational or occupational exposure to exotic fish, tissue biopsy, wound culture and prompt empirical antibiotic therapy. Once in vitro organism sensitivities are obtained, antibiotic treatment may last for up to 24 months. Surgical drainage and debridement are an important supplement to antimicrobial therapy when subcutaneous structures are involved, as in the present report. Invasive digital and hand infections can rapidly result in permanent residual stiffness, deformity and loss of function; therefore, it is important to raise awareness of the condition among those considered to be at risk.