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A Hidden Risk of "Lipotourism": Mycobacterium Infection
Patients who travel outside the U.S. for liposuction might be at risk for unusual wound infections.
Patients who elect to undergo surgical procedures, including cosmetic surgery for removal of fat, are increasingly seeking care at hospitals and clinics outside the U.S. These authors report an unusual infection seen in "lipotourists."
In 2004, the Centers for Disease Control and Prevention (CDC) investigated reports of unusual skin infections in patients who had undergone cosmetic surgery in the Dominican Republic. The CDC identified 20 cases of infection with Mycobacterium abscessus in patients who had undergone abdominoplasty; some patients also had undergone liposuction or breast augmentation or reduction surgery. The authors analyzed details of eight patients who underwent surgery at the same clinic and had related isolates. Symptoms began 2 to 18 weeks after the procedures, and most patients presented with skin abscesses. All eight patients required prolonged courses of antimicrobial therapy (clarithromycin alone or with azithromycin), and all but one were eventually cured. Patients who underwent breast augmentation required removal of the implants.
Comment: Although community-acquired methicillin-resistant Staphylococcus aureus is the most common cause of skin abscesses in patients who present to U.S. emergency departments these days, patients who have surgical procedures overseas might acquire unusual infections. Consider including azithromycin or clarithromycin in the initial treatment regimen for an infection that is related to an offshore surgical procedure. Consultation with an infectious disease specialist could be helpful.
— Diane M. Birnbaumer, MD, FACEP
Published in Journal Watch Emergency Medicine May 2, 2008
Citation(s):
Furuya EY et al. Outbreak of Mycobacterium abscessus wound infections among "lipotourists" from the United States who underwent abdominoplasty in the Dominican Republic. Clin Infect Dis 2008 Apr 15; 46:1181.
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