Abstract
Mycobacterium marinum infections are associated with specific occupational risk factors and often have a delay to diagnosis. We present the case of a young tropical fish whole-sale worker presenting with skin lesions on the hand.
A 26-year-old tropical fish wholesale worker presented to A&E with an acute flare of skin lesions on the dorsum of his right hand, without systemic symptoms. The lesions had been present for 3 weeks prior to presentation. Examination revealed a tender fluctuant swelling on the dorsum of the index metacarpophalangeal joint (Fig. 1). Three other indurated erythematous swellings were visible on the dorsum of the hand and forearm.
Blood tests were unremarkable. Aspirated fluid stained positive with Ziehl-Neelsen. A provisional diagnosis of Mycobacterium marinum was confirmed on final culture. Mycobacterium marinum is rare but should be considered in those with occupational risk: aquarium or fishery workers, and fish hobbyists. The average delay to diagnosis is over four weeks. Such ‘fish tank granuloma’ infection can be prevented by the use of waterproof gloves in groups at risk.
Figure 1:
Skin lesions.
CONFLICT OF INTEREST STATEMENT
No conflicts of interest.
FUNDING
No funding sources.
ETHICAL APPROVAL
No ethical approval required.
CONSENT
Patient consent gained on standard Trust consent form.
GUARANTOR
Guarantor S. S. Folkard.