Fishy story: paradoxical reaction associated withMycobacterium marinum

Abstract

Paradoxical reactions occur when an infection has acute worsening in response to antibiotic therapy. Here, we describe a patient with chronic cutaneous ulcerative lymphangitis that acutely worsened following initiation of antibiotic therapy. The infection was caused byMycobacterium marinum, a species which has not previously been associated with paradoxical reaction in immunocompetent persons. In this case report, we describe our patient’s diagnosis and management, review the management ofMycobacterium marinuminfection, and discuss paradoxical reactions in mycobacterial disease.