Non-tuberculous mycobacteria (NTM)-induced nodules following botulinum toxin injections are increasingly being reported. These infections can present as persistent nodules or abscesses, posing significant diagnostic and therapeutic challenges.
We report a case of a 35-year-old healthy male who developed multiple tender and painful nodules localized at injection sites on the forehead and periorbital areas three weeks after receiving Onabotulinum toxin injections from an untrusted provider. Initial treatment with oral steroids and empiric antibiotics was ineffective. Biopsy and NTM PCR confirmed the presence of Mycobacterium chelonae. The patient was successfully treated with a six-month regimen of oral clarithromycin, levofloxacin, and trimethoprim/sulfamethoxazole, resulting in complete remission without relapse at the eight-month follow-up.
A comprehensive review of the literature revealed eight reported cases of NTM-induced granulomatous nodules following botulinum toxin injections. These cases predominantly involved female patients and were associated with Mycobacterium abscessus, Mycobacterium immunogenum, and unidentified NTM species. This case is the first reported instance of Mycobacterium chelonae as an etiological agent in such a context. Effective management involves early biopsy, accurate microbiological diagnosis, and tailored antimicrobial therapy.
This case emphasizes the need for clinicians to consider NTM infections in patients with persistent nodules post-botulinum toxin injections, especially when initial treatments fail. To prevent such infections, it is crucial for patients to seek treatment from trusted and licensed providers who use authentic products and maintain sterile environments during procedures.
Citation: Joe Khodeir, Paul Ohanian, Ali Awwad. Mycobacterium chelonae-induced granulomatous nodules following botulinum toxin injections: A case report and literature review[J]. AIMS Allergy and Immunology, 2024, 8(4): 296-302. doi: 10.3934/Allergy.2024018
Non-tuberculous mycobacteria (NTM)-induced nodules following botulinum toxin injections are increasingly being reported. These infections can present as persistent nodules or abscesses, posing significant diagnostic and therapeutic challenges.
We report a case of a 35-year-old healthy male who developed multiple tender and painful nodules localized at injection sites on the forehead and periorbital areas three weeks after receiving Onabotulinum toxin injections from an untrusted provider. Initial treatment with oral steroids and empiric antibiotics was ineffective. Biopsy and NTM PCR confirmed the presence of Mycobacterium chelonae. The patient was successfully treated with a six-month regimen of oral clarithromycin, levofloxacin, and trimethoprim/sulfamethoxazole, resulting in complete remission without relapse at the eight-month follow-up.
A comprehensive review of the literature revealed eight reported cases of NTM-induced granulomatous nodules following botulinum toxin injections. These cases predominantly involved female patients and were associated with Mycobacterium abscessus, Mycobacterium immunogenum, and unidentified NTM species. This case is the first reported instance of Mycobacterium chelonae as an etiological agent in such a context. Effective management involves early biopsy, accurate microbiological diagnosis, and tailored antimicrobial therapy.
This case emphasizes the need for clinicians to consider NTM infections in patients with persistent nodules post-botulinum toxin injections, especially when initial treatments fail. To prevent such infections, it is crucial for patients to seek treatment from trusted and licensed providers who use authentic products and maintain sterile environments during procedures.
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Joe Khodeir, Paul Ohanian, Ali Awwad. Mycobacterium chelonae-induced granulomatous nodules following botulinum toxin injections: A case report and literature review[J]. AIMS Allergy and Immunology, 2024, 8(4): 296-302. doi: 10.3934/Allergy.2024018
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