A 76-year-old woman presented with a 3-day history of a worsening lesion on her right cheek. The area had become reddened and painful. She had no fever, chills, or other constitutional symptoms. She had no allergies. She was on losartan for hypertension. Two months earlier, she had been exposed to a friend with methicillin-resistant Staphylococcus aureus (MRSA).
Physical examination. A 2.5-cm, indurated, erythematous nodule with a central crust was present on the woman’s right cheek. The lesion was minimally fluctuant and was erythematous, warm, and tender. Superficially, serosanguineous drainage was noted from the center of the lesion, along with erythema of the surrounding tissue. There were no palpable cervical lymph nodes.
The lesion was incised and drained, yielding 2.0 mL of a creamy, yellow-white, purulent drainage. Culture of the drainage grew 3+ Propionibacterium acnes.
Outcome of the case. The cyst and associated infection completely responded to the surgical procedure along with a regimen of oral doxycycline monohydrate, 100 mg twice daily for 10 days.
Discussion. P acnes is part of the normal skin flora. This gram-positive organism is normally found on facial skin and hair follicles, and it is mostly recognized in the pathophysiology of acne vulgaris. Systemic infections with P acnes are rare but have been implicated in endocarditis of prosthetic valves,1 endocarditis of native valves,2 infections related to orthopedic procedures,3-7 central nervous system and cerebrospinal fluid infections of shunts,8,9 brain abscesses,10 bronchopneumonia,11 and corneal infections.12 Our patient presented with a P acnes abscess of the skin; no cases of P acnes cutaneous abscess have been reported in the literature.
Our patient was neither immunocompromised nor taking any medications associated with the development of acne, such as corticosteroids, lithium and other antipsychotics, epidermal growth-factor receptor inhibitors, anticonvulsants, cyclosporine, testosterone and anabolic steroids, tumor necrosis factor α inhibitors, and antibiotics.13 Moreover, we do not believe that the presence of P acnes was a result of contamination, given the fact that the culture sample was obtained directly from the inside of the abscess.
Although most abscesses require only simple incision and drainage, the cellulitis surrounding our patient’s lesion, the degree of associated pain, and her recent exposure to MRSA suggested infection with that pathogen, and cultures were obtained for laboratory testing.
This case was originally published in Consultant360. 2017;57(9):567-568.
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- Arnell K, Cesarini K, Lageqvist-Widh A, Wester T, Sjölin J. Cerebrospinal fluid shunt infections in children over a 13-year period: anaerobic cultures and comparison of clinical signs of infection with Propionibacterium acnes with other bacteria. J Neurosurg Pediatr. 2008;1(5):366-372.
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- Momin DB, Peterson A, Del Rosso JQ. A status report on drug-associated acne and acneiform eruptions. J Drugs Dermatol. 2010;9(6):627-636.