Disseminated Mycobacterium avium Complex Infection Causing Multiple Skull Defects in an Immunocompetent Patient: A Case Report

Abstract

Mycobacterium avium complex (MAC) infection mainly causes pulmonary disease. However, in 20% to 30% of cases, it also induces various extrapulmonary diseases. Disseminated MAC infection occasionally occurs in immunocompromised patients but very rarely in immunocompetent patients. An 80-year-old immunocompetent woman presented with multiple chronic wounds on the scalp that had not improved despite prolonged treatment. A scalp abscess caused by disseminated MAC infection 4 years ago had gone through repeated cycles of improvement and aggravation despite continued use of anti-mycobacterial agents and active wound care. Enhanced brain computed tomography and magnetic resonance imaging revealed multiple skull defects and abscesses invading the dura mater. Under general anesthesia, the infected scalp skin and bone were sufficiently removed, and the bone and soft tissue defects were repaired with cranioplasty using a titanium mesh plate and local flap. As exemplified in this case, multiple chronic wounds unresponsive to treatment need to be screened for MAC infection. As chronic MAC infection in the scalp can cause skull destruction and brain infection, it needs to be treated aggressively at an early stage to prevent serious morbidity and mortality. Effective MAC infection management involves adequate medication, regular follow-up imaging, and active surgical procedure.