Acne conglobata caused by Cutibacterium avidum

A 30-year-old man presented to our hospital with a 2-year history of massive inflammatory, nodulocystic, and painful lesions as well as an aggravation for 2 months. Clinical examinations revealed that there were massive red papules, pustules, nodules, and cysts scattered over the skin of his whole cheeks and neck, and part of his shoulder and back. Most of the pustules were filled with white secretion, and some were damaged with crust (Figure 1). A rectal temperature was 37°C.
He has taken oral isotretinoin (20 mg daily for 3 months) and nadifloxacin ointment for the therapy, but there was no significant improvement on him and the number of his skin lesions has increased.
During the hospitalization, he was diagnosed with acne conglobata through his physical examination. In his laboratory examinations, the white blood cell count (15.15 × 109/l) and neutrophil count (10.60 × 109/l) in blood routine tests were increased. The erythrocyte sedimentation rate (ESR) (40 mm/h) and C-reactive protein (CRP) (27.60 mg/l) were also significantly elevated (Figure 2).
We got the secretion sample for microbiological detection. However, no bacteria and fungi were found in the secretions in the microscopic examination. The Gram stain and acid-fast staining were also negative. But in the secretion culture of his facial secretions, the Cutibacterium (formerly Propionibacterium) avidum (C. avidum) colonies were found in the Brucella blood agar plate.
Then we used a daily dose of intravenous moxifloxacin hydrochloride (400 mg), oral isotretinoin (10 mg three times), and topical use of mupirocin ointment and nadifloxacin ointment. After a week of therapy, the skin lesions improved and he was discharged with the therapy of a daily dose of oral amoxicillin (1.5 g), isotretinoin (10 mg three times), and aforementioned external medicines. Finally, this patient had complete resolution of his symptoms at 4 months’ follow-up.
Acne conglobata is a rare and severe type of acne with interconnecting inflammatory and grouped nodules, cysts, and abscesses [1]. Acne conglobata is often resistant to conventional therapies for acne and heals with disfiguring scarring, resulting in a big impact on the mental health and patients’ quality of life [1]. Although this patient had an elevated white blood cell count, ESR and CRP, the 2-year medical history as well as numerous persistent polyporus comedones and non-inflammatory cysts suggested that the diagnosis was...


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