Facial lesion caused by Mycobacterium gordonae infection

We report a case of a patient in her 50s who first presented with cervical lymphadenopathy and later developed a slowly progressing facial lesion. After an initial lymph node biopsy, a diagnosis of cutaneous sarcoidosis was made and she was treated with immunosuppressive therapy. As the facial lesion continued to progress, a skin biopsy was performed which identified Mycobacterium gordonae In retrospect, this organism had been grown on liquid culture from the first lymph node biopsy but was dismissed as a contaminant. 15 years after the first onset of symptoms, she was commenced on multidrug antibiotic therapy, resulting in a marked improvement. This case underscores the need to interpret isolation of non-tuberculous mycobacteria in the context of clinical findings and to reconsider established diagnoses when the condition of the patient worsens.