Chronic intractable nontuberculous mycobacterial-infected wound after acupuncture therapy in the elbow joint:A case report

BACKGROUND Musculoskeletal nontuberculous Mycobacterium(NTM)infections are rare,partic-ularly post-acupuncture therapy,and present diagnostic challenges due to their infrequency and potential severity.Prompt recognition and appropriate manage-ment are crucial for optimal outcomes.NTM-infected wounds involving the joints are difficult to treat,and only a few cases have been reported.CASE SUMMARY We present a case of a chronic intractable NTM-infected wound on the elbow joint that completely healed with conservative wound care and antibiotic treatment.An 81-year-old woman presented with a chronic,ulcerative wound on the right elbow joint where she had undergone repeated acupuncture therapy for chronic intolerable pain.Magnetic resonance imaging revealed synovial thickening,effusion,and subcutaneous cystic lesions.An orthopedic surgeon performed open synovectomy and serial debridement.However,1 month postoperatively,the wound had not healed and became chronic.A wound culture revealed NTM(Mycobacterium abscessus),and the patient was referred to the Department of Plastic and Reconstructive Surgery.Instead of surgical intervention,conservative wound care with intravenous antibiotics was provided,considering the wound status and the patient’s poor general condition.Complete wound healing was achieved in 12 months,with no impact on the range of motion of the elbow joint.CONCLUSION With clinical awareness,musculoskeletal NTM infection can be treated with conservative wound care and appropriate antimicrobial agents.

Pneumatosis Cystoides Intestinalis Complicated during Chemotherapy for Pulmonary Nontuberculous Mycobacterial Disease

Background: Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by the presence of gas in the intestinal wall. Aim: We report two rare cases of PCI that are complicated during the chemotherapy for pulmonary nontuberculous mycobacterial (NTM) disease. Case Presentation: In this report, we described two cases (a 72-year-old woman and a 60-year-old woman) of PCI that appeared during the combined chemotherapy consisting of rifampicin, ethambutol and clarithromycin. Because there were few clinical symptoms and increased inflammatory responses, the diagnosis of PCI was delayed. However, there were fortunately no severe complications in both cases. Conclusion: Respiratory physicians should be aware of the potential development of PCI in patients during the chemotherapy for pulmonary NTM disease. It is important to detect PCI in the early stage through radiological examinations to avoid severe complications.

Pulmonary sequestration infected with nontuberculous mycobacteria:a report of two cases and literature review

We report two cases of pulmonary sequestration infected with nontuberculous mycobacteria(NTM): Mycobacterium avium and Mycobacterium abscessus.Chest computed tomography showed pneumonic consolidation in the right lower lobe,which received a systemic blood supply from the descending aorta in both patients.Video-assisted thoracoscopic surgeries were successfully performed and pathologica]examinations revealed multiple caseating granulomas.A review of the literature revealed only seven previous case reports of pulmonary sequestration infected with NTM,and no case with Mycobacterium abscessus has been reported.

Cervical Nontuberculous Mycobacterial Lymphadenitis Mimicking a Thyroid Tumor and Infiltrating Deep into the Neck

Aim: Nontuberculous Mycobacterial Lymphadenitis (NML), which occurs in 1.2 per 100,000 children, is very rare. And those which emerge at the anterior cervical portion and infiltrate deep into the neck are even more rare. Generally, this disorder is uncommon existed near the thyroid gland. We report here a case of NML mimicking a thyroid tumor and infiltrating into the deep part of the anterior neck. Case: A mass at the anterior portion of her neck was found at 5 years old. It was not mobile and palpated as an irregularly surfaced hard mass whose size was 3 cm at the anterior lower portion of her neck. Ultrasonography showed an oval mass which existed near the slightly inferior part of the right lobe of the thyroid gland. Enhanced computed tomography showed a mass near the slightly inferior part of the right lobe of the thyroid gland. The mass was resected with the platysma and the right sternohyoid muscle. In the HE staining, epithelioid cell and Langhans type giant cells surrounding coagulative necrosis lesions which seemed to be caseation necrosis existed, similarly to cervical NML. Discussion: No consensus exists for the treatment of NML, but many documents advise complete excision. When the lesion cannot be completely removed, excision as far as possible and additional antibiotics are recommended. The characteristics of imaging of NML around the thyroid gland and infiltrating deep into the anterior neck and mediastinum are discussed.

Molecular Epidemiology of Nontuberculous Mycobacteria in a German CF Center and Clinical Course of NTM Positive Patients

Goal of this study was to analyse the clinical course of cystic fibrosis (CF) patients with nontuberculous mycobacteria (NTM) in their respiratory secretions and to investigate the molecular epidemiology of the most prevalent NTM species by multilocus sequence analysis (MLSA). The respiratory specimen and the clinical parameters forced expiratory volume in one second (FEV1), body-mass-index (BMI), erythrocyte sedimentation rate (ESR) 1 h and immunoglobulin G (IgG) of 357 CF patients, 0 - 52.4 years, mean FEV1 2009 81.5% pred were analysed between 1998 and 2010. In 13 patients NTM were detected. 12 of 13 patients carried M. abscessus, for one patient the NTM species was not characterized. 4 patients carried a second NTM species (M. avium, M. chelonae (2x), M. intracellulare). 6 patients exhibited a significant decline in FEV1, however changes in BMI, IgG and ESR were discordant. Molecular genotyping of M. abscessus isolates revealed a unique MLSA pattern in 6 patients. 2 patients harboured identical strains, and one patient a closely related strain. Whether the presence of identical strains is attributed to the acquisition of NTM clones from common environmental sources or to patient-to-patient transmission cannot be definitely clarified. Although cross-in- fection of the three patients with identical/closely related strains in the present cohort is highly unlikely, we recommend strict hygiene measures for all CF patients harbouring NTM.

Clinical Analysis of Pulmonary Nontuberculous Mycobacterial Disease Complicated by Lung Cancer during the Follow-Up Periods

Introduction: The objective of this study was the estimation of the clinical characteristics of patients with pulmonary nontuberculous mycobacterial (NTM) disease complicated by lung cancer during the follow-up periods. Methods: We analyzed the clinical findings of four patients (2.0%) complicated by lung cancer during the follow-up periods of over six months at least after the definite diagnosis of pulmonary NTM disease of 202 patients with pulmonary NTM disease experienced in our hospital in the last decade. Results: There were four patients with pulmonary NTM disease complicated by lung cancer and all of them were caused by Mycobacterium avium complex (MAC). They were all elderly male patients and had underlying diseases. Three patients were diagnosed with primary lung cancer and one diagnosed with metastatic lung cancer from colon cancer within 3 years after the diagnosis of pulmonary NTM disease. The treatments for lung cancer were surgical resection for all patients with localized lesions. One patient died due to the worsening of underlying disease and the remaining three survived except for the recurrence of one patient. Conclusion: Although the complication rate of pulmonary NTM disease and lung cancer was a lower percentage (2.0%) than in previous reports, the careful follow-up for patients with pulmonary NTM disease without forgetting the possible complication of lung cancer is necessary.

Value of Metagenomic Next-Generation Sequencing in Clinical Diagnosis and Targeted Therapy of Nontuberculous Mycobacteria Infection

The purpose of this study was to assess the value of metagenomic next-generation sequencing(mNGS)for rapid diagnosis of diseases caused by nontuberculous mycobacteria(NTM).We retrospectively reviewed four NTM-infected cases diagnosed by smear microscopy,mycobacterial culture and mNGS methods.We found that the mNGS method not only had a shorter detection turnaround time(3–4 days)than Mycobacterium culture(15–20 days)but also had higher sensitivity and specificity to identify NTM compared with conventional detection methods.In addition,mNGS was able to identify coinfections by NTM and other bacteria,fungi or viruses.Overall,diagnosis of NTM by mNGS can provide timely and precise guidance for subsequent clinical treatment of NTM infections.

Diagnostic Value of Targeted Next-generation Sequencing in Pulmonary Mycobacterial Infections

Objective This study aimed to explore the diagnostic value of novel technique-targeted next-generation sequencing(tNGS)of bronchoalveolar lavage fluid(BALF)in pulmonary mycobacterial infections.Methods This retrospective study was conducted on patients who underwent bronchoscopy and tNGS,smear microscopy,and mycobacterial culture of BALF.Patients with positive Mycobacterium tuberculosis(MTB)culture or GeneXpert results were classified into the tuberculosis case group.Those diagnosed with nontuberculous mycobacteria(NTM)-pulmonary disease(NTM-PD)composed the case group of NTM-PD patients.The control group comprised patients without tuberculosis or NTM-PD.Sensitivity,specificity,and receiver operating characteristic(ROC)curves were used to evaluate the diagnostic performance.Results For tuberculosis patients with positive mycobacterial culture results,the areas under the ROC curves(AUCs)for tNGS,GeneXpert,and smear microscopy were 0.975(95%CI:0.935,1.000),0.925(95%CI:0.859,0.991),and 0.675(95%CI:0.563,0.787),respectively.For tuberculosis patients with positive GeneXpert results,the AUCs of tNGS,culture,and smear microscopy were 0.970(95%CI:0.931,1.000),0.850(95%CI:0.770,0.930),and 0.680(95%CI:0.579,0.781),respectively.For NTM-PD,the AUCs of tNGS,culture,and smear-positive but GeneXpert-negative results were 0.987(95%CI:0.967,1.000),0.750(95%CI:0.622,0.878),and 0.615(95%CI:0.479,0.752),respectively.The sensitivity and specificity of tNGS in NTM-PD patients were 100%and 97.5%,respectively.Conclusion tNGS demonstrated superior diagnostic efficacy in mycobacterial infection,indicating its potential for clinical application.

Epidemiology and Clinical Features of Mycobacterium avium Complex Pulmonary Disease in a Brazilian Amazon Cohort

The incidence of Mycobacterium avium complex pulmonary disease (MACPD) has been globally increasing. The present study aims to provide a comprehensive analysis of clinical characteristics and treatment response among patients in the Amazon region of Brazil and conduct a retrospective cohort study at a prominent referral hospital in the State of Par, Brazil, from 2012 to 2020. The M. avium group represented 58.9% of cases, followed by M. intracellulare (35.7%), M. colombiense (3.6%), and M. chimaera (1.8%). The majority of patients (73.2%) were female and with an average age of 63 years. Primary clinical manifestations included persistent cough and sputum production. The Charlson comorbidity index (CCI) averaged 2.47, with 36.3% of patients having a CCI score equal to higher than 3. Notably, over 70% of patients had received treatment for pulmonary tuberculosis before initiating treatment for MAC infection. The fibrocavitary radiologic form was the most prevalent (55.4%), frequently exhibiting a bilateral distribution (53.6%). Antimicrobial susceptibility revealed a significant prevalence of MAC resistance to drugs in the therapeutic regimen. Despite this, most of the patients experienced clinical improvement (50%). In conclusion, this study highlights a higher prevalence of MAC infections among middle-aged women, with a history of pulmonary tuberculosis treatment and presenting the fibrocavitary radiological form was predominant.

Nontuberculous mycobacteria： susceptibility pattern and prevalence rate in Shanghai from 2005 to 2008

Background An increasing incidence of disease caused by nontuberculous mycobacteria （NTM） is being reported. The purpose of this study was to determine the isolation rates of NTM from various clinical specimens, and their antimicrobial susceptibility patterns, over a 4-year period in Shanghai. Methods All NTM isolated between 2005 and 2008 at Shanghai Pulmonary Hospital, a key laboratory of mycobacteria tuberculosis in Shanghai, China, were identified with conventional biochemical tests and 16S rRNA gene sequencing. Antimicrobial susceptibility for all NTM was determined using the BACTEC MGIT 960 system. Results A total of 21 221 specimens were cultured, of which 4868 （22.94%） grew acid fast bacilli （AFB）, and 248 （5.09%） of the AFB were NTM. The prevalence rate of NTM was determined as 4.26%, 4.70%, 4.96% and 6.38% among mycobacteria culture positive samples in years 2005, 2006, 2007 and 2008 respectively. These data indicated that the prevalence rate has continuously increased. Sixteen different species of NTM were identified, the most commonly encountered NTM in Shanghai were M. chelonae （26.7%）, followed by M. fortuitum （15.4%）, M. kansasii （14.2%）, M. avium-intracellulare complex （13.1%） and M. terrae （6.9%）. The rare species identified were M. marinum, M. gastri, M. triviale, M. ulcerans, M. smegmatis, M. phlci, M. 9ordonae, M. szulgai, M. simiae, M. scrofulaceum and M. xenopi. The five most commonly identified NTM species showed high drug resistance to general anti-tuberculosis drugs, particularly, M. chelonae and M. fortuitum appear to be multi-drug resistance. Conclusions The prevalence of NTM in Shanghai showed a tendency to increase over the course of the study. The five most commonly isolated NTM species showed high drug resistance to first line anti-tuberculosis drugs.

Nontuberculous mycobacteria in China:incidence and antimicrobial resistance spectrum from a nationwide survey

Background:Information on the prevalence and resistance spectrum of nontuberculous mycobacteria(NTM)in China is mainly based on regional or local data.To estimate the proportion of NTM cases in China,a national survey of NTM pulmonary disease was carried out based on acid-fast positive sputum samples collected in 2013.

Drug resistance and pathogenic spectrum of patients coinfected with nontuberculous mycobacteria and human-immunodeficiency virus in Chengdu, China

Background:Human-immunodeficiency virus (HIV) infection is increasing worldwide and nontuberculous mycobacteria (NTM) is an established microbiologic cause of pulmonary disease,lymphadenitis,and disseminated disease in cases of advanced immune suppression.Data on patients coinfected with HIV and NTM are limited.Thus,this study aimed to analyze the clinical characteristics,drug resistance,and pathogen spectrum of patients coinfected with both HIV and NTM in the Chengdu area of China.Methods:Data of 59 patients coinfected with both HIV and NTM collected from the Public Health Clinical Center of Chengdu,between January 2014 and December 2018,were analyzed.NTM drug sensitivity testing was performed using the microporous plate ratio method.Data were analyzed using SPSS 19.0,and the change in drug resistance rate was analyzed using the chi-square (x2) test.Results:Seven species/complex of NTM were identified from patients coinfected with HIV and NTM in this study,with Mycobacterium avium-intracellulare complex (52.5%) and M.kansasii (27.1%) as the predominant species.Male patients were more affected 50/59 (84.7%);the mean age of the 59 cases was 45 years.The clinical characteristics mainly included anemia (86.4%),cough and expectoration (79.7%).The baseline CD4 count was <50 cells/μL (84.7%).Patients were mainly in advanced acquired immunodeficiency syndrome (AIDS) stage.Chest imaging mainly showed patchy shadows (42.4%) and nodules (32.2%),with various degrees of AIDS-defining diseases.The drug resistance of NTM was severe,and the rate of isoniazid resistance (100.0%) was the highest,followed by rifampicin (94.9%),streptomycin (94.9%),ofloxacin (93.2%),and others.Ethambutol (52.5%) and clarithromycin (33.9%) were relatively low.No significant difference was found in the drug resistance rate of NTM strain against nine antituberculosis drugs in 5 years (P > 0.05).Condusions:The immune level of patients coinfected with HIV and NTM is low in advanced AIDS stage;more male are affected in patients who are mainly infected with MAC and M.kansasii and with serious drug resistance,The drug resistance rate of ethambutol and clarithromycin is relatively low.

Clinical and Laboratory Characteristics of Patients with Nontuberculous Mycobacterium Bloodstream Infection in a Tertiary Referral Hospital in Beijing, China

Background： Nontuberculous Mycobacterium （NTM） bloodstream infection （BSI） is relatively rare. We aimed in this study to evaluate the clinical characteristics, laboratory evaluation, and outcomes of patients with NTM BSI. Methods： We retrospectively reviewed the clinical records of inpatients with NTM BSI at our institution between January 2008 and January 2015 and recorded clinical parameters including age, gender, underlying disease, clinical manifestation, organs involved with NTM disease, species of NTM, laboratory data, treatment and outcome of these patients. We also reviewed the reported cases and case series ofNTM BSI by searching PubMed, EMBASE, and Wanfang databases. Data of normal distribution were expressed by mean ~ standard deviation （SD）. Data of nonnormal distribution were expressed by median and interquartile range （IQR）. Results： Among the ten patients with NTM BSI, the median age was 51 years （IQR 29-57 years） and three patients were males. Eight patients were immunocompromised, with underlying diseases including human immunodeficiency virus （HIV） infection （one patient）, rheumatic diseases （two patients）, breast cancer （one patient）, myelodysplastic syndrome （two patients）, and aplastic anemia （two patients）. Other organ（s） involved were lung （two patients）, endocardium （two patients）, brain, spinal cord, and soft tissue （one each patient）. The median lymphocyte was 0.66 x 109/L （IQR 0.24-1 .93 × 10^9/L）. The median cluster of differentiation 4 （CD4） cell count was 179/ mm^3 （IQR 82-19/mm^3）. Five patients died （three with hematological diseases, one with breast cancer, and one with rheumatic disease）, three recovered, and two were lost to follow-up. Conclusions： We reported all cases in our hospital diagnosed with bloodstream NTM infection that was rarely reported. In this group of patients, patients usually had a high fever and could have multiple organ involvements. All patients with poor prognosis had underlying diseases.

Long-term case-fatality rate of nontuberculous mycobacterial disease in people living with HIV

Background:Few data are available regarding the long-term case-fatality rate(CFR)among people living with HIV(PLWH)with nontuberculous mycobacteria(NTM)disease.The aim of this study is to analyze the long-term CFR in patients with NTM disease and to identify risk factors for their death.Methods:A retrospective cohort study of 379 cases of microbiologically confirmed NTM disease in PLWH was conducted from January 1,2012,to December 31,2020,in Shanghai,China.We used Kaplan-Meier survival analysis and the log-rank test to compare the long-term CFR in patients with disseminated NTM(DNTM)and localized NTM disease.Univariate Cox proportional hazards regression analysis and a stepwise Cox proportional hazards regression model were used to estimate the predictors of long-term CFR.Results:The cohort was followed up for a median of 26 months.The total CFR was 15.7%by one year and increased to 22.6%at 5 years after the diagnosis of NTM disease.The 5-year CFR of PLWH with DNTM was significantly higher than that of PLWH with localized NTM(26.7%vs 19.6%for DNTM and localized NTM disease,respectively).Older age[hazard ratio(HR)=1.04,95%confidence interval(CI):1.02-1.06,P<0.001],comorbidity(HR=2.05,95%CI:1.21-3.49,P<0.01),DNTM(HR=2.08,95%CI:1.17-3.68,P<0.05),and HIV viral load(HR=1.32,95%CI:1.12-1.55,P<0.001)were all independent risk factors for long-term CFR.In the subgroup analysis,time to culture positivity was negatively correlated with CFR in patients with DNTM(HR=0.90,95%CI:0.82-0.98,P<0.05).Conclusions:NTM was associated with a high long-term CFR in PLWH.Further approaches to prevent NTM disease in PLWH are urgently needed.

Bilateral nontuberculous mycobacterial keratitis after laser in situ keratomileusis

Laser in situ keratomileusis （LASIK） is currently the most popular keratorefractive procedure performed worldwide with generally excellent outcomes. However, infectious keratitis after LASIK is a devastating, vision-threatening complication. The common pathogens were bacteria and fungi. Nontuberculous mycobacterium （NTM） accounted for a substantial proportion of these pathogens. Most NTM infections （86% of cases） were involved in unilateral cornea. In this study, we report six patients with bilateral NTM keratitis following LASIK.

Drug resistance and its clinical relevance of nontuberculous mycobacteria in Sichuan area

Objective To analyze the status of infection and drug resistance of nontuberculous mycobacteria(NTM)and its clinical relevance in Sichuan area.Methods Mycobacteria laboratory specimens from January 2014 to December 2015 in Public Health Clinical Center of Chengdu were retrospectively collected and analyzed.NTM identification was performed by gene chip or 16S

Comparing the Genotype and Drug Susceptibilities between Mycobacterium avium and Mycobacterium intracellulare in China

Objective Mycobacterium avium （M. avium） and Mycobacterium intracellulare （M. intracellulare） are the major causative agents of nontuberculous mycobacteria （NTM）-related pulmonary infections. However, little is known about the differences in drug susceptibility profiles between these two species. Methods A total of 393 NTM isolates were collected from Shanghai Pulmonary Disease Hospital. Sequencing of partial genes was performed to identify the strains at species level. The minimum inhibitory concentration （MIC） was used to evaluate the drug susceptibility against 20 antimicrobial agents. Variable number of tandem repeat （VNTR） typing was conducted to genotype these two species. Results A total of 173 （44.0%） M. avium complex （MAC） isolates were identified, including 41 （10.4%） M. avium isolates and 132 （33.6%） M. intracellulare isolates. Clarithromycin and amikacin were the two most effective agents against MAC isolates. The Hunter-Gaston Discriminatory Index （HGDI） values for VNTR typing of M. avium and M. intracellulare isolates were 0.993 and 0.995, respectively. Levofloxacin resistance was more common among the unclustered strains than among the clustered strains of M. intracellulare. Conclusion M. intrecellulare was the most common NTM species in China. Clarithromycin and amikacin had high antimicrobial activities against MAC. VNTR typing of MAC isolates revealed a high discriminatory power. Levofloxacin resistance was associated with unclustered strains of M. intracellulare.

Prevalence and Antimicrobial Susceptibility of Mycobacterium abscessus in a General Hospital, China

Objective To gain greater insight into the prevalence drug resistant profiles of M. abscessus from a general hospital in Beijing, China. Methods Partial gene sequencing of 16 S, hsp65, and rpo B were used to distinguish the species of NTM isolates. All strains identified as M. abscessus were further enrolled in the drug susceptibility testing by using broth microdilution method. Results We found that M. avium complex was the most frequent NTM organism, accounting for 54.1%（33/61） of all isolates. Behind MAC, the second most common organisms were M. abscessus（22 out of 61, 36.1%）. Average rates of resistance were 4.5% for AMK, 9.1% for LZD, and 13.6% for CLA, respectively. In contrast, resistance to LEV（17/22, 77.3%）, IMI（9/22, 40.9%）, and SMX（10/22, 45.5%） was noted in more than 40% of M. abscessus isolates. DNA sequencing revealed that all the CLA-resistant isolates harbored nucleotide substitutions in position 2058（1/3, 33.3%） or 2059（2/3, 66.7%） of 23 S r RNA. Conclusion In conclusion, our data demonstrated that M. intracellulare and M. abscessus were the most common NTM species in the general hospital of Beijing. CLA, AMK, LZD showed promising activity, where as LEV, IMI, and SMX exhibited poor activity against M. abscessus in vitro.

Lumbar infection caused by Mycobacterium paragordonae:A case report

Mycobacterium paragordonae(M.paragordonae),a slow-growing,acid-resistant mycobacterial species,was first isolated from the sputum of a lung infection patient in South Korea in 2014.Infections caused by M.paragordonae are rare.CASE SUMMARY Herein,we report the case of a 53-year-old patient who presented with fever and low back pain.Lumbar nuclear magnetic resonance imaging revealed the destruction of the lumbar vertebra with peripheral abscess formation.After antiinfective and diagnostic anti-tuberculosis treatment,the patient had no further fever,but the back pain was not relieved.Postoperatively,the necrotic material was sent for pathological examination,and all tests related to tuberculosis were negative,but pus culture suggested nontuberculous mycobacteria.The necrotic tissue specimens were subjected to metagenomic next-generation sequencing,which indicated the presence of M.paragordonae.Finally,the infecting pathogen was identified,and the treatment plan was adjusted.The patient was in good condition during the follow-up period.CONCLUSION M.paragordonae,a rare nontuberculous mycobacterium,can also cause spinal infections.In the clinic,it is necessary to identify nontuberculous mycobacteria for spinal infections similar to Mycobacterium tuberculosis.

Subcutaneous infection caused by Mycobacterium abscessus following cosmetic injections of botulinum toxin:A case report

BACKGROUND In recent years,the cosmetic intervention related infections caused by nontuberculous mycobacteria(NTM)are increasing as the informal cosmetic treatments are performed.However,many dermatologists are inexperienced in the diagnosis and management of similar cases.Here we report a case of subcutaneous infection caused by Mycobacterium abscessus(M.abscessus)following cosmetic injections of botulinum toxin.CASE SUMMARY A 53-year-old woman presented with multiple abscesses and nodules on her forehead and both temporal sites for half a month after cosmetic injections of botulinum toxin.Her lesions did not show any alleviation after 2-wk prescription of antibiotics.Laboratory examinations indicated that she had no sign of immunodeficiency and the whole body of computed tomography did not find any systemic infection or diseases.The pathology of skin tissue showed inflammatory cell infiltration with the negative results of Periodic acid Schiff(PAS)and Acidfast staining and the culture yielded no microbiome.Afterwards,the puncture on abscess was performed and M.abscessus was successfully isolated.The pathogen was identified by acid-fast staining and DNA sequencing.The patient was treated with the strategy of clarithromycin,ofloxacin,and amikacin according to the result of drug sensitivity test and got complete remission of the lesions.CONCLUSION The case presents the whole process of diagnosis and management of NTM infection after cosmetic intervention and highlights the diagnostic thoughts.In a word,the mycobacterium infection should be aware in patients after cosmetic performance.