Successful long-term management for postoperative sternal infection with multiple disseminated lymphadenitis caused by Mycobacterium abscessus.
Disseminated infection
Mediastinitis
Mycobacterium abscessus
Sternal infection
Surgical site infection
Journal
Surgical case reports
ISSN: 2198-7793
Titre abrégé: Surg Case Rep
Pays: Germany
ID NLM: 101662125
Informations de publication
Date de publication:
21 Aug 2023
21 Aug 2023
Historique:
received:
12
05
2023
accepted:
09
08
2023
medline:
21
8
2023
pubmed:
21
8
2023
entrez:
20
8
2023
Statut:
epublish
Résumé
Postoperative sternal infection caused by Mycobacterium abscessus (M. abscessus) is rare, but associated with a high 2-year mortality rate of 40%. Decision-making around treatment strategy is challenging. Here, we present a successfully treated case of postoperative M. abscessus sternal infection with multiple disseminated lymphadenitis. The patient, an 80-year-old woman with anterior mediastinal tumor and myasthenia gravis, underwent extended thymectomy under median sternotomy. Redness appeared around the scar two months after the operation. Sternal wires were removed, debridement was performed, and the wound was kept open. Mycobacterium abscessus was isolated from the wound culture. The disseminated lesions in the right axillary, parasternal, and bilateral supraclavicular lymph nodes, rendered surgical options for infection control difficult; therefore, she was treated conservatively with antibiotics and negative pressure wound therapy (NPWT). The wound diminished but infectious granulation tissue remained after NPWT. Two disseminated lesions were percutaneously punctured and drained of pus, which resulted in negative cultures. Additional debridement and wound closure were performed. She was discharged after switching to oral antibiotics. No recurrence was observed five months after the antibiotics were completed (total sensitive antibiotics use: 366 days). Repeated culture assessment of disseminated lesions is recommended to facilitate the development of appropriate therapeutic strategies. Localized procedures may be an option for patients with controlled disseminated lesions evidenced by negative cultures.
Sections du résumé
BACKGROUND
BACKGROUND
Postoperative sternal infection caused by Mycobacterium abscessus (M. abscessus) is rare, but associated with a high 2-year mortality rate of 40%. Decision-making around treatment strategy is challenging. Here, we present a successfully treated case of postoperative M. abscessus sternal infection with multiple disseminated lymphadenitis.
CASE PRESENTATION
METHODS
The patient, an 80-year-old woman with anterior mediastinal tumor and myasthenia gravis, underwent extended thymectomy under median sternotomy. Redness appeared around the scar two months after the operation. Sternal wires were removed, debridement was performed, and the wound was kept open. Mycobacterium abscessus was isolated from the wound culture. The disseminated lesions in the right axillary, parasternal, and bilateral supraclavicular lymph nodes, rendered surgical options for infection control difficult; therefore, she was treated conservatively with antibiotics and negative pressure wound therapy (NPWT). The wound diminished but infectious granulation tissue remained after NPWT. Two disseminated lesions were percutaneously punctured and drained of pus, which resulted in negative cultures. Additional debridement and wound closure were performed. She was discharged after switching to oral antibiotics. No recurrence was observed five months after the antibiotics were completed (total sensitive antibiotics use: 366 days).
CONCLUSIONS
CONCLUSIONS
Repeated culture assessment of disseminated lesions is recommended to facilitate the development of appropriate therapeutic strategies. Localized procedures may be an option for patients with controlled disseminated lesions evidenced by negative cultures.
Identifiants
pubmed: 37599318
doi: 10.1186/s40792-023-01730-8
pii: 10.1186/s40792-023-01730-8
pmc: PMC10440305
doi:
Types de publication
Journal Article
Langues
eng
Pagination
146Informations de copyright
© 2023. Japan Surgical Society.
Références
Clin Infect Dis. 2021 Apr 8;72(7):1232-1240
pubmed: 32133489
Expert Rev Anti Infect Ther. 2016 Dec;14(12):1139-1154
pubmed: 27690688
J Clin Med. 2020 Aug 06;9(8):
pubmed: 32781595
J Infect Dev Ctries. 2014 Feb 13;8(2):184-92
pubmed: 24518628
BMC Infect Dis. 2022 Apr 11;22(1):360
pubmed: 35410188
Emerg Infect Dis. 2015 Sep;21(9):1638-46
pubmed: 26295364
AJR Am J Roentgenol. 1988 Mar;150(3):605-10
pubmed: 3257618
J Card Surg. 2013 Nov;28(6):687-92
pubmed: 23941599