We report a case of catheter-related bacteremia due to Tsukamurella pulmonis. T. pulmonis is a rare cause of opportunistic infection in immunosuppressed patients and in cases of indwelling foreign materials. This infection was nearly impossible to identify using conventional phenotyping methods because of its similarities to the related genera Nocardia, Rhodococcus, Gordonia, Streptomyces, Corynebacterium, and Mycobacterium. This organism was initially misidentified as Mycobacterium aubagnense through PCR-RFLP analysis. We correctly identified this organism using 16S rRNA sequencing combined with phenotyping tests.
Bacteremia ; Catheters ; Corynebacterium ; Humans ; Korea ; Mycobacterium ; Nocardia ; Nontuberculous Mycobacteria ; Opportunistic Infections ; Rhodococcus ; Streptomyces

The genus Gordonia is one of the mycolic acid-containing aerobic actinomycetes. This genus has 38 named species that are widespread in the natural environment; however, Gordonia species rarely cause human infections. A 76-year-old woman presented with cough and sputum for over 1 year and was suspected of having nontuberculous mycobacterial (NTM) lung disease. An NTM isolate from the sputum was initially identified as Mycobacterium lentiflavum or Mycobacterium genavense by genotypic identification targeting internal transcribed spacer (ITS). However, the isolate was finally confirmed as Gordonia otitidis by sequencing of 16S rRNA, gyrB and secA1 genes. In patients with suspected NTM lung disease, the etiologic agent might be an organism other than NTM such as G. otitidis but still be identified as NTM without sequencing of 16S rRNA or other genes. Especially in case that a possible NTM isolate is identified as M. lentiflavum or M. genavense by the genotypic method targeting ITS, additional genotypic tests such as sequencing of 16S rRNA and other genes would be necessary for more reliable identification.
Actinobacteria ; Actinomycetales ; Aged ; Cough ; Female ; Humans ; Lung Diseases* ; Lung* ; Methods ; Mycobacterium ; Nontuberculous Mycobacteria ; Respiratory Tract Infections ; Sputum

Actinomycosis of cerivcofacial region is an uncommon disease and presents as an abscess or chronic lesion mimicking malignancy, tuberculosis, or fungal lesion. Actinomycosis is difficult to diagnose because of fastidious nature of the organism in culture and general lack of familiarity with the disease. So, a high index of suspicion is required to make an accurate and timely diagnosis. We present a case of male patient with actinomycosis of submandibular triangle complaining of neck mass.
Abscess ; Actinomycosis* ; Actinomycosis, Cervicofacial ; Diagnosis ; Humans ; Male ; Neck* ; Recognition (Psychology) ; Tuberculosis

Actinomyces are gram positive anaerobes which exist as normal flora in the oral and digestive tract. Actinomycosis is a very rare subacute or chronic infectious disease that causes sinus fistula, tract or abscess due to the invasion of surrounding soft tissue when normal mucosa is damaged by inflammation. Clinically, it is categorized into cervicofacial, thorax, abdomen, pelvis, and systemic infection, in which cervicofacial infection accounts for 50% of all actinomycosis. With various nonspecific clinical manifestations and uncertain results of fine needle aspiration cytology and culture examination, treatment may be difficult since it may be misdiagnosed as malignancy or tuberculosis. Along with literature, we present a case of a 57-year old male patient with cervical actinomycosis in the submandibular mass, which was mistaken for malignancy.
Abdomen ; Abscess ; Actinomyces ; Actinomycosis ; Actinomycosis, Cervicofacial ; Biopsy, Fine-Needle ; Communicable Diseases ; Fistula ; Gastrointestinal Tract ; Humans ; Inflammation ; Male ; Mucous Membrane ; Pelvis ; Thorax ; Tuberculosis

A clinical and histopathologic study was done on 48 cases of cutaneous tuberculosis among 43, 209 out-patients in Dermatologic department of Korea t.Jniversity Hospital during the period of 15 years and 9 mont4s from January, 1969 to September, 1984. These 48 cases were consistent with skin tuberculosis in histologic and clinicalI finc1ings, The result were summarized as follows: ]. The incidence of skin tuberculosis was 0 I 1 g among 43, 209 cases of outpatients. 2. Localized type of skin tuberculosis was 3. 2 times more frequent than disseminated type. Frequent skin tuberculosis was lupus vulgaris (57 3%), erythema induratum (12, 5%), tuberculosis verrucosa cutis(8.3%) and lupus milaris disseminatus faciei (8. 3%). 4, The ratio between male and fenmle was 1: l. 1. 5 The ages of onset were variable according to the types of skin tuberculosis. but 45 8% of all cases developed in the age group between 10 and 29 years. Seasonal incidences of skin tuberculosis were 52. 1% in spring, 85%, in winter, 18. 8% in summer, 4, 2%, in autumn. 7 In histopathologic findings, there were tubercle or tubrculoid structures in all cases and typical tubercle structures were observed in 18.8% The ratio of accordance between the histopathologic diagnosis and clinicopa thologic diagnosis was 81.3%.
Diagnosis ; Erythema Induratum ; Humans ; Incidence ; Korea ; Lupus Vulgaris ; Male ; Outpatients ; Seasons ; Skin* ; Tuberculosis ; Tuberculosis, Cutaneous*

Methotrexate (MTX) has been established as a standard disease-modifying anti-rheumatic drug. If adequate disease control is achieved for a reasonable period of time, tapering the MTX dosage is recommended because the chronic use of MTX can result in opportunistic infection. We present here a case of a woman with rheumatoid arthritis taking MTX, and the woman developed actively caseating endobronchial Mycobacterium intracellulare disease with pulmonary infiltrations. After discontinuing the MTX, the patient was able to tolerate 18 months of antimycobacterial treatment without flare ups of rheumatoid arthritis, and she completely recovered from nontuberculous mycobacterial respiratory disease.
Arthritis, Rheumatoid ; Bronchial Diseases ; Female ; Humans ; Lung Diseases ; Methotrexate ; Mycobacterium ; Mycobacterium avium Complex ; Nontuberculous Mycobacteria ; Opportunistic Infections ; Tuberculosis, Pulmonary

Chronic granulomatous infection of the skin and soft tissue by nontuberculous mycobacteria in patients with normal immune system is rarely reported. This case was about a child patient, with normal immune system, whose lower leg was lacerated after a slip down in the Philippines and it was previously treated at a hospital in the Philippines. After a couple of surgical debridement of the wound, the cause of the soft tissue infection was found to be a combined infection of nontuberculous mycobacteria and mycobacterium tuberculosis. We present a case that has been rare in Korea, but common overseas.
Child ; Debridement ; Humans ; Immune System ; Korea ; Leg ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria ; Philippines ; Skin ; Soft Tissue Infections

We report the first Korean case of lung diseases caused by Mycobacterium abscessus subsp. bolletii in a previously healthy male, except for a previous history of pulmonary tuberculosis and bronchiectasis. All serial isolates are identified as M. abscessus subsp. bolletii by multi-locus sequence analysis based on the hsp65, rpoB, and 16S rRNA fragments. At the genetic level, the isolate has the erm(41) gene with a T28 sequevar, associated with clarithromycin resistance, and no rrl mutation. The isolate is resistant to clarithromycin. Although the symptoms and radiographic findings have improved after combination of antibiotics, the follow-up sputum cultures are persistently positive.
Anti-Bacterial Agents ; Bronchiectasis* ; Clarithromycin ; Follow-Up Studies ; Humans ; Lung Diseases* ; Lung* ; Male ; Mycobacterium Infections, Nontuberculous ; Mycobacterium* ; Nontuberculous Mycobacteria ; Sequence Analysis ; Sequence Analysis, DNA ; Sputum ; Tuberculosis, Pulmonary

Atypical mycobacteria, widely distributed in nature, are opportunistic infection strain, rare pathogen in immunocompetent patients. Recently, the increase of invasive cosmetic treatment and surgery has increased the infection of atypical mycobacteria. We report a case of cutaneous infection by Mycobacterium fortuitum and Mycobacterium intracellulare that occurred after a fat graft. A 62-year-old female patient presented painful, erythematous nodules and purulent discharge on her face after a fat graft. A skin biopsy and culture were performed. Polymerase chain reaction-hybridization to identify mycobacterium other than tuberculosis revealed M. fortuitum and M. intracellulare. The patient was treated with clarithromycin, rifampicin, and ethambutol for 1 month after excision and drainage of pus, after which the skin lesions improved. In cases of refractory cutaneous infection after an invasive cosmetic procedure, atypical mycobacterial infection should be suspected.
Biopsy ; Clarithromycin ; Coinfection* ; Drainage ; Ethambutol ; Female ; Humans ; Middle Aged ; Mycobacterium avium Complex* ; Mycobacterium fortuitum* ; Mycobacterium* ; Nontuberculous Mycobacteria ; Opportunistic Infections ; Rifampin ; Skin ; Suppuration ; Transplants* ; Tuberculosis

Nocardiosis is usually a subacute infection, which can occur as an opportunistic infections in patients with systemic lupus erythematosus. There are rare cases of nocardiosis concurrent with Mycobacterium tuberculosis. We report a case of intramuscular nocardial abscess concurrent with pulmonary tuberculosis in a patient with lupus nephritis. She has received cyclophosphamide pulse therapies and is receiving oral steroid therapy 3 months ago. After Nocardia farcinica and Mycobacterium tuberculosis were confirmed by PCR and PCR-RFLP, we initiated trimethoprim/ sulfamethoxazole and antituberculous agents. After then, patient was improved and discharged, maintaining the medications.
Abscess* ; Cyclophosphamide ; Humans ; Lupus Erythematosus, Systemic ; Lupus Nephritis* ; Mycobacterium tuberculosis ; Nocardia Infections ; Nocardia* ; Opportunistic Infections ; Polymerase Chain Reaction ; Sulfamethoxazole ; Tuberculosis, Pulmonary*