Treatment of a Chronic Multidrug-Resistant Cutaneous Mycobacterium chelonae Infection of the Hand with Wide Debridement and Skin-Grafting

Case: We present a case of a healthy thirty-seven-year-old woman with a chronic cutaneous Mycobacterium chelonae infection of the hand recalcitrant to antibiotics and excisional biopsies. She was treated with wide excision of the lesion and staged full-thickness skin-grafting. At the sixth-month follow-up, she reported no activity limitations and demonstrated full painless digital motion without evidence of recurrent infection. Conclusion: The technique presented offers the advantage of early digital range of motion with temporary soft-tissue coverage prior to definitive coverage with a full-thickness skin graft while laboratory analysis is performed. Mycobacterium chelonae is a rapidly growing and ubiq-uitous nontuberculous Mycobacterium species that iscommonly found in tap water and soil1-4. Typically associated with local trauma to soft tissue, its rapid growth can result in disseminated cutaneous infections2,3,5. The incidence of nontuberculous mycobacterial cutaneous infections ap-pears to be rising, with concomitant emergence of multidrug-resistant species3,5,6. Additionally, the involvement of the hand or finger may add to the complexity of treatment because issues of coverage and timing must be adequately addressed. To date, reports on the surgical treatment of chronic cutaneous myco