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Zoonotic infections associated with animal bite injuries are common and can result in severe illness (1,2). Approximately 5 million animal bites occur annually in North America, and 10 million injuries occur globally from dog bites alone (2,3). Pathogens causing infections after dog or cat bites are well described; pathogens from other animal bites are less well defined, although their oral microbiota are known (1). We report a case of cutaneous Mycobacterium marinum infection after an iguana bite to inform clinicians of potential infectious etiologies of lizard bites.
A previously healthy 3-year-old girl was on vacation with her family in Costa Rica. She was eating cake on the beach when an iguana approached her. While attempting to take the cake, the animal bit the dorsum of her left hand. She was immediately taken to a local clinic and found to have a single, superficial bite wound over the dorsum of her third metacarpal. The wound was immediately disinfected and irrigated; she was prescribed a 5-day course of oral amoxicillin. The family returned to the United States after the incident. Her wound completely resolved over the ensuing days without immediate complications.
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Five months after the bite, her parents noted a small lump on the dorsum of her left hand that was not present previously. The child was otherwise well. The lump became progressively larger, erythematous, and mildly painful over the next 3 months (Figure, panel A). Because of persistent symptoms, her parents sought medical attention at Stanford Medicine Children’s Health (Stanford, California, USA). Although ultrasound demonstrated findings suggestive of a ganglion cyst (Figure, panel B), the location and symptoms were not consistent with this diagnosis. She saw an orthopedic surgeon who, given the progression and...