Mycobacterium chelonae linked to tattoo-related skin infections

Mycobacterium chelonae was the culprit in a small outbreak of skin infections following tattoo placement, according to a presentation at the 67th Annual Meeting of the American Academy of Dermatology.

Lisa Drage, MD, of the Mayo Clinic in Rochester, Minn., presented data on the outbreak of cases that presented between October 2007 and May 2008.

Drage said that most patients presented to their physicians with papules and pustules within one to two weeks of tattoo placement. Most of the patients had already received antibiotics and topical steroids, but were referred for further treatment when the infection did not abate.

One characteristic that was similar among all patients was that they all had received a popular “gray wash” treatment of tattooing, which takes the black ink typically used in tattooing and mixes it with tap water. “The gray wash is often used to give a photo-like appearance,” Drage said. The papules were generally clustered in the gray wash areas.

The researchers noted that the histopathology results of five immunocompetent patients revealed lymphohistiocytic infiltrates, granulomatous changes or a mix. While waiting for sensitivity results, most patients were started on clarithromycin, and all isolates later were shown to be sensitive.

Drage said that the diagnosis was made by culture in three patients, histologic diagnosis in one patient and by clinical and epidemiological observation in the other two patients. Five of the patients demonstrated clinical response to antibiotic treatment at 25 weeks, and one patient was lost to follow-up.

Drage said that although the patients generally presented for treatment within two weeks of tattoo placement, the mean time to diagnosis of M. chelonae was 17.6 weeks.

“The patterns of the pustules followed the needlepricks.” Drage said. Drage said the researchers were able to home in on one particular tattoo artists’ gray wash. While the gray wash had been discarded by the artist after he received reports about the infection, Drage said someone had received a tattoo in another area of just black ink and did not exhibit signs of infection at that site.

Drage said this outbreak was a good reminder to physicians to avoid use of tapwater in patient care settings, since tapwater is the primary source of M. chelonae outbreaks. – by Colleen Zacharyczuk

For more information:

Drage L. #P205. Presented at: the 67th Annual Meeting of the American Academy of Dermatology; March 6-10, 2009; San Francisco.