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Here, we describe a patient with chronic cutaneous ulcerative lymphangitis that acutely worsened following initiation of antibiotic therapy. The infection was caused by <jats:italic>Mycobacterium marinum<\/jats:italic>, a species which has not previously been associated with paradoxical reaction in immunocompetent persons. In this case report, we describe our patient\u2019s diagnosis and management, review the management of <jats:italic>Mycobacterium marinum<\/jats:italic> infection, and discuss paradoxical reactions in mycobacterial disease.<\/jats:p>","DOI":"10.1136\/bcr-2024-261308","type":"journal-article","created":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T22:31:04Z","timestamp":1724970664000},"page":"e261308","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Fishy story: paradoxical reaction associated with <i>Mycobacterium marinum<\/i>"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8579-4302","authenticated-orcid":false,"given":"Alexander M","family":"Tatara","sequence":"first","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA"},{"name":"Medicine, The University of 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