Mycobacterium marinum infections (fish tank granuloma) are infrequently encountered and when they do arise, they can pose a diagnostic challenge for clinicians. They can present as non-healing wounds along with several other presentations that may not be typical, as patients can have other comorbidities that cause immunosuppression and invasive symptoms of the disease. Treatment regimens vary in length, and are based on the patient’s response to treatment couple with resolution of symptoms. Rifampicin and ethambutol are effective treatment options, together with use of macrolides. A thorough history from patients must be taken as to establish contact with aquatic animals.