Concomitant late soft tissue infections by Cladophialophora bantiana and Mycobacterium abscessus following tsunami injuries

A Swedish man and woman sustained severe soft tissue injuries during the tsunami catastrophe in Thailand in December 2004, and subsequently received partial thickness skin grafts after multiple surgical revisions. Four to six weeks post trauma they displayed signs of purulent infections in the non-traumatized, virtually intact skin outside the resection margins. Skin biopsies revealed granulomatous reactions and pigmented fungal hyphae were observed in specimens from the male patient. Cladophialophora bantiana and Mycobacterium abscessus were recovered concomitantly from samples obtained from both patients. Antifungal treatment was given with voriconazole for one month, after which no fungal growth was detected on biopsies. Antimycobacterial treatment was given with clarithromycin and amikacin. The symptoms gradually subsided in the male patient, but recurrent abscesses were noted with the female patient, from which M. abscessus was recovered despite prolonged antibiotic therapy.