Eur J Orthop Surg Traumatol (2010) 20:71–74 DOI 10.1007/s00590-009-0490-2 123 CASE REPORT Mycobacterium fortuitum associated with fasciotomy in an immunocompetent patient Elba L. Rangel-Gamboa · Rigoberto Hernández-Castro · Roberto Arenas · Judith Domínguez-Cherit · Rodolfo Vick · José Díaz · Miriam Bobadilla del Valle · Erika M. Carrillo-Casas · Bárbara Chávez-Mazari · Luis Rodríguez-Cruz Received: 18 March 2009 / Accepted: 13 May 2009 / Published online: 2 June 2009  Springer-Verlag 2009 Abstract A 40-year-old woman presented with a skin disease, characterized by con Xuent erythematous nod- ules and purulent material discharges, which aVected the right arm. A Ziehl–Nielsen stain of purulent material revealed the presence of acid-fast bacilli. The isolated microorganism was identi Wed by standard biochemical procedures as a member of the Mycobacterium fortuitum group. Molecular identi Wcation performed by ampli Wca- tion and sequencing of the 16S rRNA revealed 100% identity with strains of M. fortuitum. The following report reveals an extensive cutaneous aVection caused by M. fortuitum in a non-predisposed immunocompetent patient. Keywords Mycobacterium fortuitum · Fasciotomy · 16S rRNA · Immunocompetent Introduction The genus Mycobacterium has at least 95 members, while leprosy and tuberculosis are speciWc diseases caused by mycobacteria. The non-tuberculous mycobacteria (NTM) can be saprophytes, opportunistic and at times deadly pathogens. These atypical mycobacteria have been classi- Wed into four groups according to their biochemical fea- tures [1], among them rapidly growing mycobacteria (RGM) are capable of causing several clinical diseases in both immunosuppressed and immunocompetent patients. RGM are frequently acquired from environmental sources, including water, soil and dust, but can be also hospital acquired [2]. These Mycobacterium are nowadays remerg- ing in Africa, but in America have an infrequent presenta- tion [1]. Based on the diVerences in the 16S rRNA gene nucleotide sequence [3, 4], RGM were classiWed into three groups: Mycobacterium fortuitum group, M. chelonae- abscessus, and M. smegmatis [5]. Recently, M. fortuitum has emerged as an opportunistic pathogen. In immuno- compromized individuals, these agents can cause a wide disease spectrum including pulmonary disease, lymphade- nitis, osteomyelitis and bacteremia [6, 7]. In immunocom- petent individuals, the emerging infections include mainly those of the skin and soft tissue, post-traumatic injuries, dermatology surgery, keratitis, and surgical and subcutane- ous infections [1, 8]. The present report reveals an exten- sive cutaneous infection caused by M. fortuitum in an immunocompetent patient without predisposing factors. Moreover, it underlines the adequate antibiotic use sup- ported by molecular identiWcation of the etiological agent. E. L. Rangel-Gamboa · R. Hernández-Castro (&) · E. M. Carrillo-Casas Dirección de Investigación, Hospital General “Dr. Manuel Gea González”, Calzada de Tlalpan 4800, Sección XVI, 14080 Mexico City, Mexico e-mail: rhc@servidor.unam.mx R. Arenas · J. Domínguez-Cherit · J. Díaz Servicio de Dermatología, Hospital General “Dr. Manuel Gea González”, Calzada de Tlalpan 4800, Sección XVI, 14080 Mexico City, Mexico R. Vick Servicio de Infectología, Hospital General “Dr. Manuel Gea González”, Calzada de Tlalpan 4800, Sección XVI, 14080 Mexico City, Mexico M. B. del Valle · B. Chávez-Mazari · L. Rodríguez-Cruz Laboratorio de Microbiología Clínica del Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Vasco de Quiroga 15, Sección XVI, 14000 Mexico City, Mexico