TY - JOUR T1 - Fish tank granuloma - A case report from Sri Lanka JF - European Respiratory Journal JO - Eur Respir J VL - 44 IS - Suppl 58 SP - P2628 AU - Dushantha Madegedara AU - Damith Nandadeva AU - Rajitha Abeysekera AU - Sumeesha Samarabandu AU - Rasheeka Liyanaarachchi Y1 - 2014/09/01 UR - http://erj.ersjournals.com/content/44/Suppl_58/P2628.abstract N2 - We describe a case of Mycobacterium marinum infection which started following a cut injury sustained while cleaning a fish tank. A 51-year old patient presented with a history of episodically discharging skin lesion over the right thumb for 10 years duration which had recently started enlarging in size for 3 months duration. He was being treated for focal segmental glomerular sclerosisand his treatment had been changed to ciclosporin 4 months before due to inadequate response.The dormant skin lesion increased in size following this.A large nodule was observed on the right thumb which had an unhealthy skin over it with healed openings which had drained beforeSystemic examination was normal. ESR 52 mm,Mantoux 13mm and CXR was normal. X-ray of the thumb revealed visible soft tissue swelling with no evidence of underlying osteomyelitis or calcification. Skin biopsy histology of the lesion revealed acanthotic epidermis with underlying granulation tissue with ill-defined aggregate of histiocytes and neutrophils. PAS staining for fungi was negative. The appearances were consistent with a fish tank granuloma.Patient was started on Rifampicin,Ethambutol and Clarythromycinand regression of the lesion was present at 3 months.Atypical mycobacterial infections are not uncommon. To avoid diagnostic delays, clinicians need to have a high index of suspicion for M.marinum infection, especially when patients are immunocompromised. ER -