Chronic Granulomatous Infection of Soft Tissue Complicated by Trauma of a Lower Leg

Kyungho Park; Kwangyoung So; Minwook Kim; Yongsoo Choi

doi:10.4055/jkoa.2012.47.4.293

Journal List > J Korean Orthop Assoc > v.47(4) > 1013166

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Park, So, Kim, and Choi: Chronic Granulomatous Infection of Soft Tissue Complicated by Trauma of a Lower Leg

Case Report

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(4): 293-298.

Published online: 27 August 2012

DOI: https://doi.org/10.4055/jkoa.2012.47.4.293

Chronic Granulomatous Infection of Soft Tissue Complicated by Trauma of a Lower Leg

Kyungho Park, M.D., Kwangyoung So, M.D., Minwook Kim, M.D., Yongsoo Choi, M.D., Ph.D.

Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea.

Correspondence to: Yongsoo Choi, M.D., Ph.D. Department of Orthopaedic Surgery, Kwangju Christian Hospital, 37, Yangnim-ro, Nam-gu, Gwangju 503-715, Korea. TEL: +82-62-650-5060, FAX: +82-62-650-5066, stemcellchoi@yahoo.co.kr

Received 28 February 2012 Revised 16 April 2012 Accepted 8 May 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords: mycobacterium tuberculosis, nontuberculous mycobacteria, soft tissue infections, skin infections

Figures and Tables

Figure 1

Preoperative photograph shows erythematous swelling with pus-like discharge and wound dehiscence on a lower leg.

Figure 2

The magnetic resonance images show ill defined soft tissue swelling and contrast enhancement at the anteri or subcutaneous tissue of the lower leg, left. But, there was no remarkable finding at the bone and muscle.

Figure 3

The three phase bone scan shows no specific abnormal finding at the wound. RT, right; LT, left; ANT, anterior; POST, posterior.

Figure 4

After adequate excision of the wound, rotational flap was performed for the soft tissue defect.

Figure 5

Pathologic findings show mixed chronic granulomatous and acute inflammation in dermis and subcutis (a: ×100, b: ×400, H&E stain, A). There are revealed some acid-fast bacilli (black arrows) within vacuoles (×400, Ziehl-Neelsen stain, B).

Figure 6

(A) At 7 weeks after the operation, the wound healed. (B) But at 9 weeks after the operation, pus discharge at the wound recurred.

Figure 7

The photographs of the wound taken (A) at 5 months after the operation, (B) at 7 months after the operation, (C) at 9 months after the operation, and (D) at 18 months after the operation.

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