Tattoo-Associated Cutaneous Mycobacterium mageritense Infection: A Case Report and Brief Review of the Literature

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Abstract
There have been increasing reports of tattoo-associated mycobacterial infections in recent years, with a number of outbreaks documented worldwide. This has therefore become a public health concern. Nontuberculous mycobacteria (NTM) are capable of producing skin and soft tissue infections typically via inoculation during surgery, trauma, and cosmetic procedures. We present a case of tattoo-associated cutaneous infection caused by Mycobacterium mageritense, a rare species of rapidly growing NTM. A 25-year-old man developed a rash on his left lower leg 4 weeks after he underwent professional tattooing. A skin swab identified M. mageritense complex. Based on susceptibility testing, a course of oral ciprofloxacin and trimethoprim/sulfamethoxazole was initiated, with significant improvement observed after 5 weeks. We speculate that the mechanism of inoculation was a result of either the artist using nonsterile water to dilute black ink to gray or from use of contaminated prediluted gray ink. The Therapeutic Goods Administration does not have regulatory authority over the sterility of tattoo inks or practices in Australia. Instead, tattoo practices are regulated by local government jurisdictions. Because of the variability seen in clinical presentation and challenges associated with organism identification, a high index of suspicion is required to diagnose mycobacterial infections. Infection caused by NTM should be considered in the differential diagnosis of tattoo-associated dermatological complications, particularly in patients who have chronic lesions, negative bacterial cultures, and fail to respond to standard antibiotic therapy. Mandatory regulations for safe tattoo practices should be considered to prevent outbreaks and ensure public safety.

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