Care and treatment of a rare Mycobacterium avium complex-infected wound: a case report

An unusual presentation of Mycobacterium avium complex (MAC), unlikely to be encountered in an outpatient dermatology setting, was diagnosed in a patient without an immunodeficiency. A 47-year-old woman, who was immunocompetent and had no risk factors, presented with a full-thickness, infected wound (large amounts of purulent exudate and severe pain) on her back, which had been present for two months. She was diagnosed as having an MAC infection, using a DNA microarray chip method. The patient underwent wound drainage and a fresh silver-containing dressing was applied daily for two months. Although systemic antibiotics were given for one week and anti-tuberculous medication for one month, there was no response. She also complained of bloating, nausea, loss of appetite and other problems, apparently due to drug-induced liver damage, confirmed by laboratory tests. Based on her characteristics and a literature review related to MAC infection, we implemented an individualised, holistic care protocol for the patient that included a daily diet of appropriate fresh vegetables and fruits, and adequate high-quality protein, aerobic exercises for two hours per day, and sleep for 6-8 hours per day, to alleviate the iatrogenic liver damage, improve immune function and reduce the stress response. The wound continued treatment with sharp debridement as needed, and fresh antimicrobial silver-containing dressings every other day. Wound size was measured once a week to evaluate the effects. The wound healed after 48 days, and the patient was followed-up for 18 months at the outpatient wound care centre and through social media. No recurrence or scar hyperplasia was observed.