A Case of Rare Facial Infection Caused by Mycobacterium scrofulaceum

In July 2024, our hospital confirmed a rare case of facial infection with Mycobacterium scrofulaceum. The patient visited our hospital due to pain and pus discharge from the right orbital incision for one month. The patient suffered multiple facial fractures due to trauma three months ago. He underwent systemic anti infection treatment and open reduction and internal fixation surgery at an external hospital. After the surgery, there was repeated swelling around the orbit, and the patient did not fully recover. One month ago, the infraorbital area was swollen again, locally ruptured, and purulent discharge was visible. After self-flushing and dressing change, the condition improved. Recently, there has been swelling around the eye socket again. In order to seek further treatment, he came to our hospital for treatment. Outpatient diagnosis: 1. Multiple space infections in the right orbit, temporal region, and skull base; 2. Postoperative open facial bone fracture.

CT (skull and neck), facial wound pus: bacterial culture and identification, acid fast staining, Gram staining, T-SPOT tuberculosis infection detection, identification of Mycobacterium species (DNA microarray chip method), Metagenomic Next-generation Sequencing (mNGS). Other related auxiliary examinations included blood routine, urine routine, liver function, kidney function, electrocardiogram, etc. Results: CT (skull and neck) results: 1. After multiple fractures of the maxillofacial bone and anterior skull base, there is abnormal enhancement density shadow in the right maxillofacial region, indicating infection. Clinical laboratory tests: blood routine + high-sensitivity CRP (whole blood): white blood cell count 9.66 x 109/L, total neutrophil count 6.87 x 109/L, whole blood high-sensitivity C-reactive protein 46.21 mg/L, coagulation function: fibrinogen detection 6.61 g/L, D-dimer determination 1,231.52 FEU/L, inflammatory markers: interleukin-6 15.48 pg/mL, procalcitonin 0.037 ng/ml; Liver function test: total protein 85.2 g/L, globulin 44.4 g/L, aspartate aminotransferase 12.8 U/L. Facial wound pus examination: T-SPOT tuberculosis infection test: positive, with 40 antigen stimulated pore spots. Bacterial Gram staining: A small amount of Gram positive bacilli were found. Acid fast staining: acid fast bacilli detected ++: bacterial culture + identification: growth of mycobacteria ++, identification of mycobacterial species (DNA microarray method): Mycobacterium scrofulaceum, identification of Metagenomic Next-generation Sequencing (mNGS): Mycobacterium scrofulaceum. Clinical treatment plan: Chlorpheniramine 200 mg/d, Clarithromycin 0.5 g/d; Moxifloxacin 0.4 g/d, locally applied with 3% boric acid solution wet compress to enhance local wound dressing change. After 2 months of hospitalization, the patient's orbital swelling significantly improved, no obvious purulent discharge was observed locally, and the infection indicators significantly decreased. The patient improved and was discharged from the hospital.

This article reports a rare case of facial infection caused by Mycobacterium scrofulaceum. Mycobacterium scrofulaceum was quickly and accurately identified through mycobacterial strain identification (DNA microarray chip method) and mNGS. Reasonable treatment measures were adopted clinically, and the patient improved and was discharged. We hope that in the future, this study can provide assistance for the clinical diagnosis and treatment of Mycobacterium scrofulaceum infection.