A patient is admitted with an infected wound from a cosmetic procedure performed abroad. The wound is draining purulent material and acid-fast bacilli (AFB) are seen on stain. Which organism is the most likely cause?

• A. Mycobacterium tuberculosis
• B. Mycobacterium kansasii
• C. Mycobacterium abscessus
• D. Mycobacterium leprae

Answer: (C)

Postoperative wounds after cosmetic procedures abroad are classically caused by rapid-growing non-tuberculous mycobacteria. These organisms stain acid-fast due to their cell wall, and they often produce draining, purulent wounds that are slow to heal and may resist standard antibiotics.

Mycobacterium abscessus is the best fit here because it is a rapid-growing non-tuberculous mycobacterium that frequently causes skin and soft tissue infections after surgical or cosmetic procedures. It presents as purulent, draining wounds and is notorious for being difficult to treat due to intrinsic antibiotic resistance, which aligns with the clinical scenario.

Other mycobacteria are less likely in this context: Mycobacterium tuberculosis typically causes pulmonary TB or disseminated disease rather than a localized post-surgical wound infection. Mycobacterium kansasii mainly causes pulmonary disease in older adults with underlying lung disease. Mycobacterium leprae causes leprosy, with nerve involvement and characteristic skin lesions, not an acute purulent wound.