Mycobacterium Abscessus Infection Following Injections of Botulinum Toxin: A Report of Two Cases

Botulinum Toxin A has become popular worldwide and is considered a safe treatment protocol.The complications are usually transient and minimal.Injection site infections or long-term reactions are rare.Here, we report 2 cases of Mycobacterium abscessus infection following injection of botulinum toxin of dramatic clinical repercussions and prolonged treatment.Case 1, a 61-year-old woman after receiving botulinum injections presented papules and nodules in her forehead and periorbital areas and diffuse frontal edema.Papules became erythematous nodules, and purulent drainage occurred.The lesions did not show any alleviation after the prescription of corticosteroids and broad-band antibiotics.The incisional biopsy of skin tissue showed inflammatory cell infiltration.Afterward, the puncture on the abscess was performed and Mycobacterium abscessus was successfully isolated.The patient was treated with the strategy of linezolid, cefoxitin, and amikacin, according to the result of the drug sensitivity test.The treatment lasted five months and led to an aesthetic sequel.Case 2, a 31-year-old woman after three days of receiving facial botulinum injections presented violaceous and fibrous nodules.Laboratory tests also showed Mycobacterium abscessus.The patient was treated with linezolid, tigecycline, and amikacin and got complete remission of the lesions after four months.The consequences caused by aesthetic procedures are rarely discussed and can significantly impact the patient's self-esteem and physical and psychological status.