Infection by Mycobacterium abscessus as a Complication of Calcium Hydroxyapatite Injection: A Case Report and Literature Review

Non-surgical aesthetic procedures for managing skin aging have seen increased demand in recent years, among which are injectable collagen bio-stimulators such as calcium hydroxyapatite. These procedures aim at preventing aging and improving skin laxity. Some complications, such as the formation of nodules, hypersensitivity reactions, and granuloma formation, have been reported. In this article, we present a literature review on Mycobacterium abscessus infection following subdermal injection of calcium hydroxyapatite in a 56-year-old healthy woman who developed nodules on the forehead and malar region one month after the application. A culture of a skin biopsy fragment revealed the presence of Mycobacterium abscessus resistant mycobacteriosis, with the patient treated with clarithromycin, amikacin, and tigecycline for 30 days in an inpatient setting. After discharge, treatment continued with oral clarithromycin and doxycycline for 6 months, resulting in clinical cure. There are few reports in the literature of atypical mycobacteriosis following dermal application of bio-stimulators.