RESUMO
Pasteurella multocida (P. multocida) is an anaerobic Gram-negative coccobacilli belonging to the Pasteurella genus. It is found in many animals' oral cavities and gastrointestinal tracts, including those of cats and dogs. In this case report, we present an individual with cellulitis of the lower extremity who was later found to have P. multocida bacteremia. The patient had four pet dogs and one pet cat. He denied obtaining any scratches or bites from the pets. The patient initially presented to an urgent care center complaining of a one-day history of proximal left lower extremity edema, erythema, and pain. He was diagnosed with left leg cellulitis and discharged home on antibiotics. Three days after the patient was discharged home from the urgent care center, blood cultures returned positive for P. multocida. The patient was then admitted for inpatient treatment with intravenous antibiotics. Clinicians should always ask about domestic and wild animal exposure, even in the absence of bites or scratches. In the immunocompromised patient presenting with cellulitis, clinicians should consider the possibility of P. multocida bacteremia in those with pet exposure.
RESUMO
Cosmetic surgeries are very popular and glamorized by the mainstream media and celebrities. Many individuals perceive certain bodily features as appealing for physical attraction and will attempt to obtain these features by surgery. However, these surgeries are not without risk, and significant consequences can occur if not performed by qualified medical professionals under sterile procedures. The authors present novel cases of two healthy young female patients who underwent a Brazilian butt lift (BBL) procedure a week apart by the same plastic surgeon in Mexico and developed dark painful lesions secondary to Mycobacterium abscessus (M. abscessus), a multidrug-resistant non-tuberculous mycobacterium (NTM). The literature review shows a paucity of data concerning NTM infections via surgical procedures of this type. The first case was of a 31-year-old woman who underwent a BBL and presented with bilateral dark painful buttock lesions weeks later. The patient returned to the plastic surgeon, who drained some lesions and prescribed oral antibiotics. The patient's clinical status continued to deteriorate and presented to the hospital for further assessment. The patient was initially started on broad-spectrum antibiotic therapy. The patient was found to have an HIV infection with a relatively preserved CD4 lymphocyte count and was started on antiretroviral therapy (ART). Intraoperative excisional tissue sample cultures grew M. abscessus. The patient was started on empiric tigecycline, cefoxitin, and linezolid. Preliminary culture susceptibilities showed resistance to linezolid. Linezolid was discontinued, amikacin was started, and cefoxitin and tigecycline were continued. Tigecycline, cefoxitin, and amikacin were continued and final susceptibilities showed sensitivity to the current treatment. The patient received a total of four months of treatment with tigecycline, cefoxitin, and amikacin. The second case was of a 28-year-old woman who underwent a BBL a week after the first patient by the same surgeon and developed multiple gluteal and body abscesses. The patient underwent bilateral thigh and gluteal, right chest wall, and breast surgical debridements with intraoperative cultures at a different hospital facility, which grew M. abscessus. Susceptibilities were not performed there. The patient was transferred to our facility for further care. Intraoperative cultures remained negative, and the patient was treated with a six-month course of tigecycline, cefoxitin, and amikacin.
