Mycobacterium senegalense soft tissue infection successfully managed by surgical debridement alone without antimycobacterial therapy: A case report

Background We report a case of 51-year-old female worker who developed a soft tissue infection of the left lower extremity following traumatic laceration. Despite empirical antimicrobial therapy at the hospital in her hometown for over nine days, the wound progressively deteriorated with skin necrosis and purulent discharge. She achieved complete healing after two surgical procedures. Case presentation The patient presented with a chronic wound on her left lower extremity following traumatic laceration. Admission wound culture was negative, and intraoperative tissue culture yielded only Corynebacterium striatum. She underwent surgical debridement with vancomycin-loaded bone cement implantation and subsequent split-thickness skin grafting, without receiving any antimycobacterial agents, and achieved complete healing with no recurrence during 22 months of follow-up. Retrospective nanopore targeted sequencing performed on the archived admission specimen detected a polymicrobial community including Mycobacterium senegalense, Staphylococcus aureus, Candida albicans, and Corynebacterium striatum. Based on clinical correlation, Mycobacterium senegalense was identified as the genuine pathogen, while the other organisms were considered colonizers. Conclusions To our knowledge, this is the first documented case of trauma-related Mycobacterium senegalense soft tissue infection in mainland China. This case suggests that for localized non-tuberculous mycobacteria soft tissue infection in an immunocompetent host, adequate surgical source control may suffice even when the pathogen remains unidentified and no antimycobacterial therapy is administered. In addition, using a molecular tool in this polymicrobial setting helped differentiate the true pathogen from co-detected colonizers, thereby preventing unnecessary antimicrobial therapy. This case is reported in accordance with the CARE guidelines.