Cutaneous infection caused by Mycobacterium boenickei due to lipolysis injection: A case report

Cosmetic injection has emerged as a significant cause of cutaneous infections associated with rapidly growing mycobacteria (RGM). Mycobacterium boenickei , a rare RGM first isolated from a leg wound in the United States in 2004, has been reported in only six strains worldwide. However, clinical case of M. boenickei infection have not been displayed in detail. Here we report the first detailed case of M. boenickei infection at an injection site following lipolysis treatment in an immunocompetent woman in China. The pathogen was initially identified through rpoB and hsp65 sequencing from DNA extracted from skin lesion, which was further confirmed by whole genome sequencing of the culture. The patient was successfully treated with a combination of rifabutin, moxifloxacin, and clarithromycin based on the result of drug susceptibility test. This case report expands the limited literature on uncommon mycobacteria infections and emphasizes the importance of molecular identification and drug susceptibility test in guiding treatment strategies. • First detailed report of Mycobacterium boenickei infection following cosmetic injection • Emerging risks of rare non-tuberculous mycobacteria in cosmetic procedures • Prolonged combination therapy guided by drug susceptibility testing with favorable outcome • Critical role of molecular identification, drug susceptibility test, and long-term follow-up in managing rare mycobacterial infections.