September 2021 - Case of the Month
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 54 year-old man was referred to clinic with a three month history of a rash that started on his right hand and spread up the forearm. The rash was non-tender and the patient was otherwise well.
There was no relevant personal or family history of skin problems.
The patient was on no medication.
He worked in an office-based job, and his main interest were tropical fish, having an aquarium at home.
Several, non-tender nodules on his right hand and forearm.
What is the diagnosis?
The diagnosis is mycobacterium marinum.
Mycobacterium marinum is a non-tuberculous mycobacteria (syn. atypical mycobacteria).
The organisms primary habitat is fresh and salt water. In fresh water mycobacterium marinum prefers warmer water, especially if not replenished, with tropical fish tanks being a frequent source of infection.
As with this patient, the hands and forearms are the commonly affected sites if the infection is acquired from tropical fish tanks. The feet and lower legs are the predominant sites if the infection is acquired through swimming.
Mycobacterium marinum presents as a nodule or pustule, which may ulcerate. If untreated lesions often spread proximally.
Confirming a diagnosis of cutaneous tuberculosis can be very difficult - please refer to the chapter on Mycobacterial infections for further information on cutaneous mycobacterial infections, which includes notes on diagnostics.
Unlike other mycobacterial infections, treatment of mycobacterium marinum is relatively straightforward. Localised infection may be treated with 3-4 months of doxycycline or clarithromycin, in more troublesome cases rifampicin may need to be added in.
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 52 year old man presented with a one year history of skin lesions predominantly on his hands, ears and scalp. He was also complaining of painful swollen fingers associated with morning stiffness. There was no family history of skin or joint problem...
A 72 year old man was referred with a rash, predominantly on the legs. The patient was systemically well and the lesions were only mildly symptomatic. The lesions presented as one to several at a time lasting several weeks. They had not res...
Welcome back to the new look PCDS website, and our first case. This lady was referred as a 2-week wait with a changing lesion on the right temple.
A 15 year old lady was referred for a diagnostic opinion for skin changes presenting in birth, affecting the right upper back, shoulder, antecubital fossa and dorsal wrist. The patient was asymptomatic and otherwise well.
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