Cutaneous Mycobacterium abscessus infection in a sporotrichoid pattern: diagnostic and therapeutic insights

A woman in her 40s presented with painful nodules and ulceration over the medial aspect of her left foot, following a thorn prick while walking barefoot. Initial treatment with antibiotics and intralesional corticosteroid injection was unsuccessful. Dermoscopy revealed a bright red to yellow structureless area with thick whitish structures at the periphery. The tissue specimen obtained from the lesion and submitted for histopathology revealed granulomatous inflammation and mycobacterial culture revealed Mycobacterium abscessus on Lowenstein–Jensen medium and matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry. She was treated with oral clarithromycin and minocycline for 12 weeks with complete resolution. This case highlights the prevalence of infections in tropical regions and the challenges and delays in their early recognition and management; hence, a proper diagnostic approach is required for treating physicians.