M 41, multiple subcutaneous nodules, recent onset

    A 41-year-old man with a past history of chronic hepatitis-C infection, poly-substance abuse, and psychiatric illnesses had undergone a right below-the-knee amputation for cellulitis. He was admitted to the hospital for evaluation of his psychiatric condition and for substance abuse. In the hospital, he had recurrent fever with night sweats and shaking chills. He also developed several non-erythematous 0.5-2.0 cm subcutaneous nodules on his legs, arms, abdomen, and fingers. A punch biopsy of a leg nodule was obtained for bacterial, mycobacterial, and fungal cultures as well as routine histologic examination. The direct acid-fast stain of the biopsy was negative but the mycobacterial culture was positive for growth at 4 days. The organism was identified as Mycobacterium abscessus. A susceptibility test followed the isolation.