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Mycobacterium immunogenum skin infections: two different presentations

Though the tuberculous variety of mycobacteria has developed greater notoriety with the general public, cases of infection with nontuberculous mycobacteria (NTM) have become a growing healthcare concern. Nosocomial outbreaks with NTM have occurred most often in association with plastic surgery procedures, abscesses at injection sites, and postoperative wound infections, particularly of the sternum. The source of the NTM can often be traced back to a hospital’s water supply, and efforts to eradicate the tenacious organism with chemicals and heat have proven difficult. Water in the natural environment has also been shown to harbor NTM and has been implicated in the pathogenesis of cutaneous infections occurring in both industrialized nations and tropical regions of the world. Although immunocompromised individuals are known to be more susceptible to NTM infections in general, a surprising number of cases in the literature describing cutaneous infection with NTM involve healthy patients with few co-morbidities. Perhaps the greatest challenge is the proper diagnosis of an NTM infection, as the clinical presentation can vary widely and a high index of suspicion must exist for a clinician to consider pursuing the culture of these fastidious organisms. We report two cases of a recently described species of NTM, Mycobacterium immunogenum, causing different skin presentations.