Nontuberculous Mycobacterial Infection After Fractionated CO2 Laser Resurfacing

Donna A. Culton; Anne M. Lachiewicz; Becky A. Miller; Melissa B. Miller; Courteney MacKuen; Pamela Groben; Becky White; Gary M. Cox; Jason E. Stout


Emerging Infectious Diseases. 2013;19(3) 

In This Article

Case-Patient 2

A 52-year-old woman underwent fractionated CO2 laser resurfacing of the neck at the same private clinic as case-patient 1 (66 days after case-patient 1 was treated). After case-patient 1 was treated, major changes were made in the treatment protocol to make the procedure sterile. Treatment was performed at 30 mJ (treatment level 7) with 25% coverage (total 2.96 kJ) but otherwise as for case-patient 1. Nine days after the procedure, painful pustular lesions developed within the treated area but primarily on the right neck (Figure 3, panel A). The patient reported adherence with instructions to avoid washing with tap water for 72 hours after the procedure and denied any other exposures. Treatment was initiated with valacyclovir, cephalexin, and topical antimicrobial drugs.

Figure 3.

A) Right lateral neck of a 52-year-old woman (case-patient 2) 9 days after fractionated CO2 laser resurfacing. B) Neck of the patient after 4 months of multidrug therapy.

After this patient did not show improvement, a biopsy specimen from a lesion showed suppurative and granulomatous dermatitis, which suggested NTM infection. Empiric treatment for NTM infection was initiated with azithromycin and moxifloxacin; some improvement in the lesions was subsequently observed. The organism was identified as M. chelonae. Drug susceptibility testing showed resistance to cefoxitin and trimethoprim/sulfamethoxazole; intermediate susceptibility to ciprofloxacin; and susceptibility to amikacin, clarithromycin, linezolid, and tobramycin. Treatment was continued with azithromycin and moxifloxacin for 4 months and clinical improvement was observed (Figure 3, panel B).