Nontuberculous mycobacterial infections, which are often acquired from
environmental sources such as water and soil, exhibit a variety of cutaneous
manifestations that frequently lead to misdiagnoses and delays in treatment. A
77-year-old woman presented with multiple skin lesions in a sporotricoid
distribution on her right leg, which persisted despite standard antibiotic
treatments. Based on the skin biopsy, revealing granulomatous inflammation with
acid-fast bacilli, and PCR testing, a nontuberculous mycobacterial infection was
diagnosed. Antimycobacterial drug combinations, including clarithromycin,
isoniazid, and rifampicin for 4 months, complete the skin lesion's
clearance. This case underscores the need for heightened suspicion and the use
of appropriate diagnostic techniques, including tissue biopsies and molecular
methods such as PCR.