A 50-year-old patient diagnosed with systemic lupus erythematosus (SLE) for four years.
During his evolution he presented as intercurrence an antiphospholipid syndrome and lupus nephritis that required treatment with oral anticoagulants, azathioprine 100 mg/day, hydroxychloroquine 200 mg/day and prednisone
In 1996 a bilateral mastectomy was performed due to a direct family history of breast cancer and mammogram findings of microcalcifications grouped in both breasts.
With histopathological diagnosis of severe dysplasia, textured breast prosthesis were placed by submuscular route.
In August 2008, she underwent a bilateral breast augmentation due to encapsulation and skin retraction. A retromuscular textured prosthesis was placed with a mammary incision.
One month after the procedure, she began with febrile equivalents, swelling and erythema in both breasts.
Bladder tissue ultrasound showed a clear and minimal contralateral right periprosthetic collection.
She was prescribed rest ice.
After a transient improvement, the symptoms returned and amoxicillin/clavulanic acid (3 gr/ day) was prescribed, which was then modified to ciprofloxacin associated with clindamycin.
Subsequently, he consulted an infectologist who advised him to withdraw both breast prosthesis given the finding of bilateral deformities; however, he did not seek medical attention.
She subsequently developed spontaneous drainage of secretion in the right breast. A surgical evacuation was performed, obtaining a citrin-like liquid that was sent to culture.
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Samples obtained were standardized according to the following protocol: Ziehl Neelsen stain, direct smear microscopy Jinkbrense and Low Sen staining.
The development speed was at 5 days (at 37 °C); pigmented colony: non-chromagenic; negative niacin test; positive catalase reaction at room temperature and at 68°C; positive reduction.
Under the suspicion of rapidly growing nontuberculous mycobacteria, the strain was referred to the National Administration of Laboratory and Institutes of Health "Dr Carlos G. Malbrán".
Laboratory tests showed the following values: hematocrit 32%, hemoglobin 10.6 gr%, leukocyte count 6.040/mm3 (neutrophils: first 71%, lymphocytes: 9.4%), red blood cell count 6.040/mm3 (neutrophils: 71%, red blood cell count:
The patient consulted the Infectious Diseases Department of the Hospital Interzonal General de Agudos "Gral San Martín" where ciprofloxacin 750 mg every 12 hours was indicated associated with cotrimoxazole 40 mg/day.
Subsequently, the Malbrán Institute completed the enriched Dubos medium typing, reporting that it was Mycobacterium tuberculosis alternative to beta-lactamase obtaining a minimum inhibitory concentration (MIC) and a minimum bacterial inhibition concentration (MIC) of 99.
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With this report it was decided to continue with the same treatment and it was suggested the removal of the prosthesis to what the patient once again became infected.
The patient remained stable, with frank voiding of the right breast swelling and intermittent secretion in the contralateral breast.
