Mycobacterium tuberculosis infection following polyacrylamide hydrogel (Amazingel) breast augmentation: A case report and literature review.

[RATIONALE] Polyacrylamide hydrogel (PAAG) injection for breast augmentation is linked to long-term complications like inflammation and infection, with bacterial infections being well-documented. However, mycobacterial infections following such procedures are extremely rare, making this case clinically significant for enhancing awareness of unusual pathogens in post-PAAG complications.

[PATIENT CONCERNS] A 42-year-old female reported persistent right breast pain, and the wound failed to heal for a long time after surgery to remove the injected material, 15 years after undergoing PAAG injection for breast augmentation. These symptoms persisted despite prior interventions, causing significant discomfort and prompting further medical evaluation.

[DIAGNOSES] The initial assessment misdiagnosed the condition as a bacterial infection. However, subsequent acid-fast bacilli staining of wound secretions and TBseq Ultra-gene sequencing confirmed the presence of Mycobacterium tuberculosis, leading to a definitive diagnosis of mycobacterial infection.

[INTERVENTIONS] The patient received a 2-month intensive anti-tuberculosis regimen consisting of rifampicin, isoniazid, ethambutol, and pyrazinamide. This targeted therapy was initiated following the confirmation of M tuberculosis infection.

[OUTCOMES] After completing the 2-month anti-tuberculosis treatment, the patient achieved complete wound healing. A 3-month follow-up period showed no recurrence of symptoms, indicating successful resolution of the infection.

[LESSONS] This case emphasizes that M tuberculosis should be considered a potential pathogen in refractory soft tissue infections following PAAG injection. Clinicians must maintain a high index of suspicion for mycobacterial infections when wounds fail to respond to standard therapies. Early use of acid-fast staining and molecular diagnostics (e.g., gene sequencing) is critical for timely and accurate diagnosis, enabling targeted treatment to improve patient outcomes.