By the time dermatologist Dr. Mark Goldgeier saw the patient, it was clear that this was no simple allergy.
He performed a skin biopsy so he could take a closer look at the rash under a microscope. What he saw was startling: the sample was riddled with a wormlike bacterium related to tuberculosis.
"I explained [to the patient] that he had TB, and he had a look of horror on his face," Goldgeier said.
For the patient, the finding meant a trip to an infectious disease specialist to start up to a full year of treatment.
Goldgeier, meanwhile, called the Monroe County Health Department.
"As soon as biopsy came back," he said, "I knew something in the process of tattooing was involved -- the ink, the water used for dilution, the syringes, the dressings."
And so began a nationwide medical mystery.
An article published Wednesday in the New England Journal of Medicine describes how this one dermatologist helped connect the dots in an outbreak of tattoo-related atypical skin infections.
Dr. Byron Kennedy, public health specialist at Monroe County Department of Public Health, took over the case from Goldgeier. Kennedy first confirmed the results by repeating a skin biopsy on the patient. Once again, tendrils of mycobacterium chelonae, a type of tuberculosis-related skin bacteria, showed up in the sample.
Mycobacterium chelonae is a rapidly growing bug found in soil, dust, water, animals, hospitals, and contaminated pharmaceuticals. This family of bacteria does not commonly affect healthy individuals, but in patients with suppressed immune systems -- like those with HIV or on chemotherapy -- these bacteria can cause serious disease, often resulting in death.
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