Rare non-tuberculous mycobacterial infection following hyaluronic acid injection

Background: Non-tuberculous mycobacterial (NTM) infections are an emerging complication of injection treatments and may lead to delayed diagnosis when routine cultures are insufficient. Case presentation: We present a case of a woman in her 50s with a chronic ulcerative lesion following hyaluronic acid injections administered abroad. Her history included prior nasal trauma and a silicone implant. Initial empirical treatment and repeated routine cultures were unsuccessful. Only after extended aerobic and anaerobic incubation and referral for molecular analysis were Mycobacterium wolinskyi, a rare rapidly growing NTM, together with Cutibacterium acnes identified. The patient was successfully treated with a 14-week course of ciprofloxacin and doxycycline alongside implant removal. Interpretation: This case underscores the importance of providing thorough clinical information on microbiology requisitions, especially in suspected foreign body infections or after injection treatments, and the need for heightened awareness of NTM infections.