Anabolic Steroid AbuseAnabolic steroids are synthetic substances similar to the male hormone testosterone. Doctors prescribe them to treat problems such as delayed anabolic steroid skin infection and other medical problems that cause the body to make very low amounts of testosterone. Steroids make muscles bigger and bones stronger. They also dbol tablets gains cause puberty to start and can help some boys who have a genetic disorder to grow more normally. Anabolic steroids may be taken as a pill, as a shot into a muscle, anabolic steroid skin infection as a gel or cream rubbed on the skin. Common anabolic steroid medicines include fluoxymesterone such as Halotestin and nandrolone such as Durabolin. In the United States, you need a prescription to get any anabolic steroid.
Anabolic Steroid Injection Infections including Abcess Problems
Mycobacterium fortuitum is a rare cause of recurrent skin abscesses in an immunocompetent person. We report the case of a year-old man presenting with multiple recurrent non-healing skin abscesses. Culture of the abscess wall yielded growth of M fortuitum. In our case, we highlight the association of anabolic steroids with non-tuberculous mycobacterial skin abscesses that fail to resolve despite repeated drainage. Abscesses requiring incision and drainage present to surgeons frequently. However, it is important to be aware of unusual presentations of abscesses.
Those that do not resolve following a surgical procedure or multiply without an obvious cause must be investigated with tissue cultures and wound swabs in order to obtain an accurate diagnosis as inoculation with mycobacteria could be a rare cause. A year-old Caucasian man working as a mechanic presented to the emergency department with a solitary swelling on the right side of his chest wall.
He had previously had an incision and drainage of the abscess on the same site while working in the Middle East. He was not diabetic and was immunocompetent. He had injected anabolic steroids in the pectoral muscles for body building in the past. It was incised and drained under general anaesthesia and he was discharged home with a course of oral amoxicillin and clavulanate mg three times a day for seven days.
A routine bacterial culture of the wound showed no significant growth. The patient presented again a week later with recurrence of the abscess.
Further incision and drainage was performed and again the swabs did not yield any bacterial growth. A week later, he presented for a third time with yet another recurrence. The abscesses were erythematous, tender and discharging pus. He underwent further drainage of the abscess cavities. On this occasion, a tissue sample was sent for histology and microbiology analysis. The impression at this time was one of hidradenitis suppurativa Fig 1.
These indurated and multiple abscesses required a fourth round of surgery. There were no acid-fast bacilli demonstrated on special staining. However, the diagnosis was thought to be probable tuberculosis. The patient was referred to the respiratory physicians for treatment of tuberculosis. However, the tissue culture isolated a very resistant Mycobacterium fortuitum , and so he was treated with ciprofloxacin mg twice daily and doxycycline mg daily.
He was unable to tolerate ciprofloxacin and was switched to a second line quinolone in the form of moxifloxacin mg daily and continued on doxycycline mg daily. Unfortunately, he developed side effects with the second quinolone and this was also discontinued.
The extensive antibiotic resistance pattern meant there were few oral treatment options. Computed tomography of the chest excluded secondary pulmonary involvement. The respiratory physician referred him back for further surgical excision with a view to obtain clear margins. He was reviewed in the surgical clinic few weeks later. The wound had healed completely Fig 3.
Histology revealed only fibrous scar tissue and no evidence of any granulomatous inflammation. M fortuitum is a fast-growing, non-tuberculous mycobacterium that was discovered in the s. It has been most commonly found nosocomially, after contamination of a surgical wound and following prostheses insertion, especially after prosthetic breast implantation 2 or orthopaedic operations.
M fortuitum is usually found in the immunocompromised, for example following chemotherapy 4 and long-term steroid therapy. He was investigated for human immunodeficiency virus and found to be negative. In our case, we have seen a rare complication of anabolic steroid injection, which may have contributed by both suppressing the immune system and inoculating the organism.
Immunological effects of anabolic steroids depend on the type of steroid and the dose administered. Common androgens such as testosterone and nandrolone may focus preferentially on altering immune function by reducing natural killer cell activity and inhibiting the maturation of stem cells into B lymphocytes.
At supraphysiological doses, they influence cytokine production directly. All these effects in combination affect immunocompetence although long-term effects are still unproven. M fortuitum is mostly sensitive to amikacin, cefotaxime, gentamicin quinolones and tetracyclines.
Although macrolide sensitivity is often detected in vitro, M fortuitum contains an inducible resistant gene. Ciprofloxacin and doxycycline are therefore the most common antibiotics used to treat this type of infection. In the majority of cases, dual therapy is recommended. The course of antibiotics should be continued for 4—6 months. If abscesses are thought to be due to mycobacterial infection, it is important to institute a two-step treatment: To our knowledge, this is the first reported case of an association between anabolic steroid injection and M fortuitum infection.
In this case, surgical excision and prompt antimicrobial treatment achieved a local cure. The key message from our report is that recurrent non-healing skin abscesses should be treated with suspicion for rare organisms, including mycobacterium, and tissue samples should be sent for histology and microbiology. National Center for Biotechnology Information , U. Ann R Coll Surg Engl. Published online Jan. Accepted Aug This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC. Abstract Mycobacterium fortuitum is a rare cause of recurrent skin abscesses in an immunocompetent person. Mycobacterium fortuitum , Cutaneous abscess, Anabolic steroids.
Case history A year-old Caucasian man working as a mechanic presented to the emergency department with a solitary swelling on the right side of his chest wall. Open in a separate window. The incised and drained abscesses prior to the administration of antibiotic therapy. The healed abscesses after surgical debridement and antibiotics therapy.
Discussion M fortuitum is a fast-growing, non-tuberculous mycobacterium that was discovered in the s. Conclusions To our knowledge, this is the first reported case of an association between anabolic steroid injection and M fortuitum infection. Skin disease and nontuberculous atypical mycobacteria. Int J Dermatol ; Haiavy J, Tobin H. Mycobacterium fortuitum infection in prosthetic breast implants. Plast Reconstr Surg ; Mycobacterium fortuitum infection following patellar tendon repair: J Bone Joint Surg Am ; Mycobacterium other than tuberculosis MOTT infection: J Infect ; Phaeohyphomycosis and Mycobacterium fortuitum abscesses in a patient receiving corticosteroids for sarcoidosis.
J Am Acad Dermatol ; Acta Derm Venereol ; Spontaneous breast abscess due to Mycobacterium fortuitum. Clin Infect Dis ; Soft tissue abscess caused by Mycobacterium fortuitum. Anabolic androgenic steroids effects on the immune system: Cent Eur J Biol ; 4: Ann Dermatol Venereol ; Support Center Support Center.