Swimming pool granuloma

Last Updated: 2019-08-26

Author(s): Anzengruber, Navarini

Fischtankgranulom, Aquariumgranulom, swimming pool granuloma, fish tank granuloma, fish fancier's finger, surfers' nodules, fish-handlers' nodules.

Atpygian mycobacteriosis. Infectious disease caused by Mycobacterium marinum. The contact to mostly tropical ornamental fish is groundbreaking for the diagnosis. 

  • Inoculation of the pathogens by small skin lesions when cleaning an aquarium, or when swimming, diving, etc. 

  • Pathogen: Mycobacterium marinum (syn. Mycobacterium balnei).
  • Erythematous-blueish, ulcerating nodule or granulomas. Spreading from the skin into deeper tissue including joints and bones is possible.

  • Clinic.

  • Biopsy with dermatopathological and microbiological processing.
  • Acra, back of the hand, elbow, back of the foot and knees.

Tubercle with central necrosis. 

  • Spontaneous healing after 12-24 months.
  • Prophylaxis 
  • Wear gloves when cleaning the aquarium.

  • Spontaneous healing after 12-24 months.
  • Nevertheless, therapy is indicated (to avoid further infection).
  • Doxycycline p.o. 100 mg 2x per day 

  • Clarithromycin p.o. 1000 mg 1x per day

  • Cotrimoxazole (sulfamethoxazole/trimethoprim) p.o. 800/160mg 2x per day 

 

  • Combination therapy with
  • Rifampicin p.o. 600 mg 1x per day and 
  • Ethambutol p.o. 15-25 mg/kg bw/d.
  • Excision of smaller herd, if necessary.
  • Cryosurgery.

  1. Van Dyke JJ , Lake KB. Chemotherapy for aquarium granuloma. JAMA 1975;233:1380-1.
  2. Contorer P , Jones RN. Minocycline therapy of aquarium granuloma. Case reports and literature review. Cutis 1979;23:864-8.
  3. Engbaek HC, Thormann J , Vergmann B. Aquarium-borne Mycobacterium marinum granulomas. Scand J Infect Dis 1980;12:74-8.
  4. Streit M, Bohlen LM, Hunziker T, Zimmerli S, Tscharner GG, Nievergelt H et al. Disseminated Mycobacterium marinum infection with extensive cutaneous eruption and bacteremia in an immunocompromised patient. Eur J Dermatol 2006;16:79-83.
  5. Iyengar KP, Matar HE, Jayeola AO , Loh WY. Flexor pollicis longus tenosynovitis caused by Mycobacterium marinum infection. BMJ Case Rep 2014;2014.
  6. Kaneko S, Seishima M, Asano Y, Chinuki Y , Morita E. Mycobacterium marinum infection in a case of psoriasis treated with antitumor necrosis factor alpha antibody detected by QuantiFERON((R)) -TB test. Int J Dermatol 2014;53:e187-9.
  7. Ko DY , Song KH. Mycobacterium marinum infection occurring on the face. J Dermatol 2013;40:773-4.