Mycobacterium marinum osteomyelitis of the first metatarsal

Mycobacterium marinum (MM) infections secondary to injuries occurring in the aquatic environment have been widely described in literature, especially in immunosuppressed patients. The most frequent locations are the hands and forearms in patients exposed to water. The infection usually presents as a granuloma affecting superficial structures. However, due to the difficulty of diagnosis and the chronic course of the condition, deeper structures may eventually become affected. Late presentation of deep-seated infections in bones in the foot is exceptional. We report a case of osteomyelitis of the first metatarsal bone caused by MM after accidental puncture injury by a sea urchin requiring surgical treatment in a not immunosuppressed patient.