Más allá de la estética: infección crónica por Mycobacterium abscessus posterior a lipotransferencia glútea

Mariel Solís Hernández
Laboratorio Clínico Hospital México, Caja Costarricense del Seguro Social, San José, Costa Rica.

Iveth Jiménez Badilla
Laboratorio Clínico Hospital México, Caja Costarricense del Seguro Social, San José, Costa Rica.

Carlos Martínez Calderón
Laboratorio Clínico Hospital México, Caja Costarricense del Seguro Social, San José, Costa Rica.

Resumen

Mycobacterium abscessus es una micobacteria de crecimiento rápido cada vez más implicada en infecciones de piel y tejidos blandos posteriores a procedimientos estéticos. Presentamos el caso de una mujer de 21 años, previamente sana, que desarrolló abscesos glúteos bilaterales con fiebre y secreción purulenta tras una lipotransferencia realizada en una clínica privada. El tratamiento inicial con antibióticos convencionales fue ineficaz y el diagnóstico definitivo se estableció mediante cultivo e identificación por MALDI-TOF - MS (Matrix-Assisted Laser Desorption/Ionization Time-Of-Flight Mass Spectrometry), detectando a la especie M. abscessus. El manejo requirió múltiples lavados quirúrgicos y un esquema antimicrobiano prolongado con amikacina, ciprofloxacina y claritromicina, por más de dos años. La evolución se caracterizó por recurrencias, efectos adversos del tratamiento y repercusiones físicas y psicológicas, con secuelas permanentes. Este caso evidencia los retos diagnósticos y terapéuticos de las infecciones por M. abscessus y resalta la importancia de la sospecha clínica y el manejo multidisciplinario, además de la necesidad de medidas regulatorias estrictas en procedimientos estéticos para prevenir este tipo de infecciones.

Palabras claves

Mycobacterium abscessus, micobacterias no tuberculosas, micobacteria, Costa Rica, infección de herida quirúrgica.

Abstract

Mycobacterium abscessus is a rapidly growing mycobacterium increasingly associated with skin and soft tissue infections following cosmetic procedures. We report the case of a previously healthy 21-year-old woman who developed bilateral gluteal abscesses with fever and purulent drainage after undergoing gluteal lipotransfer at a private clinic. Initial treatment with conventional antibiotics was ineffective, and the diagnosis was established through culture and MALDI-TOF identification, which detected the species M. abscessus. Management required multiple surgical debridements and a prolonged antimicrobial regimen including amikacin, ciprofloxacin, and clarithromycin, for more than two years. The clinical course was marked by recurrences, drug-related adverse effects and significant physical and psychological sequelae. This case highlights the diagnostic and therapeutic challenges of M. abscessus infections and underscores the importance of clinical suspicion and multidisciplinary management, in addition to the need of regulatory measures in cosmetic procedures to prevent such types of infections.

Keywords

Mycobacterium abscessus, nontuberculous Mycobacteria, Costa Rica, skin and soft tissue infection, cosmetic procedure.

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