Dear Dr. Roach: In December 2023, I had an open-heart aortic valve replacement. All went well, but then I contracted a staph infection. I had to have a second procedure to remove the top four sternal wires, leaving me with a baseball-sized wound that required a vacuum drain and antibiotics. During my treatment course, my infectious disease doctor informed me that there was another bacterium found that was unidentifiable and sent out of province to find out what it was. It turned out to be Mycobacterium cosmeticus, for which there are no known antibiotics to fight it, as it is very rare.
With this new information, I had all the sternum wires removed, which required a third procedure. My vacuum drain was removed, and I am now being treated with wound dressings. I was again noted to have a staph infection, and I am now starting my second round of cefazolin today. But still, there were no antibiotics found to kill the mycobacterium.
My question is: Why am I not dead? If it won’t kill me, there surely must be some kind of symptoms to expect. No one can answer these questions.
K.D.
Infectious complications, such as a wound infection, after an open-heart surgery are not rare. Staphylococcus aureus is a frequent culprit, and cefazolin is an excellent treatment. Proper wound care and antibiotics are the mainstays of treatment.
Mycobacteria are a unique class of bacteria. Tuberculosis is the most important disease caused by mycobacteria, but there are many others in this family. M. cosmeticus is a newly described bacteria, which was first reported in 2004 from a nail salon (hence the name).
First, it is not true that there aren’t any antibiotics to treat this. A rare case of a lung infection from M. cosmeticus was successfully treated with a combination of four medicines that are commonly used to treat tuberculosis.
Second, not all infections, especially not all skin infections, need to be treated with antibiotics. Abscesses are commonly treated by draining them. Although we often also use antibiotics, drainage is the key part of treatment, and these usually heal without antibiotics.
It’s useful to remember that before antibiotics were discovered in the early 20th century, most people were successfully cured of infections with wound care and supportive measures. Now that some bacteria have become resistant to all antibiotics, we occasionally need to rely once again on the surgical techniques that have been used to treat serious infections for centuries.
Dear Dr. Roach: I have a venous lake on my lip. My dermatologist referred me to a plastic surgeon, but after consulting with him, I am hesitant to have a procedure that drastic. I am considering asking the dermatologist for a different type of referral, but what?
S.L.
A venous lake is a benign condition of the skin, and although they can show up on the face or ears, I most commonly see these on the lips, where it looks like a bluish blister. They seem to disappear when compressed with a glass slide.
You don’t need to do anything about it at all if you don’t want to, but if its appearance bothers you, or it frequently bleeds, it can be treated with surgery. An alternative is laser treatment. Most plastic surgeons have experience with this, too.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
