Abstract

GANGLIONAR INFECTION IN A DIABETIC PATIENT CAUSED BY Mycobacterium vaccae

Cudberto Contreras Pérez, Carlos A. Vázquez Chacón and José D. Méndez*

ABSTRACT

We present the case of a diabetic patient who developed a cutaneous lymph node infection caused by a fast growing mycobacterium, identified as Mycobacterium vaccae. The infection is likely to have had a primary pulmonary focus and later to spread lymphatically, affecting two nodes in the posterior neck region. The evolution time was 1.5 months. The puncture material of the lesion revealed occasional acid resistant bacilli and the culture in Löwenstein-Jensen, incubated at 37 oC, showed development of fast-growing, scothochromogenic mycobacteria that initially formed bright, white-yellowish smooth colonies which then produced an orange pigment. The culture was identified by molecular biology tests, amplifying a fragment of the gene, which encodes the 65 Kda heat shock protein. The amplicon was restricted with the enzymes BstEII and HaeIII. With the first enzyme, there was no digestion and with the second one, three bands of 175, 80 and 65 bp were obtained, whose identification algorithm corresponds to the Mycobacterium vaccae species. The patient was treated with limecycline, 600 mg / day. An apparent improvement was observed after 15 days, with complete regression of the lesions at one and a half months. The treatment was continued for 1.5 months and the patient was discharged.

Keywords: Lymph node mycobacteriosis, Limecycline, Mycobacterium vaccae.