Fig. 2

Serial images of the patient’s right foreleg. (a) Photograph taken four days after the traffic accident at a hospital in Hanoi following surgical debridement and suture of the wound. (b, c) Six weeks after the accident a firm subcutaneous nodule was noted (b), which drained spontaneously the next day (c). The soft tissue infection persisted despite four weeks of empiric antimicrobial treatment (sixth to tenth week after the accident) (d) leading to the decision to perform surgical debridement and subsequent skin grafting as well as local flap surgery 11 weeks after the trauma (e). (f) A tissue biopsy was obtained 19 weeks after the accident when abscesses and nodules reappeared within a few weeks upon surgical debridement and intravenous empiric antibiotic therapy. (g-i) After 20 weeks, antimycobacterial treatment was initiated following susceptibility testing of the identified Mycobacterium fortuitum: Photographs show the status before (g), eight weeks after antimycobacterial therapy (h) and upon completion of the four-month therapy regimen (i). The patient was followed-up, continuous improvement was noticed nine months (j), 12 months (k) and 14 months after the initial accident (l)