Atypical Mycobacterial Infection Presenting as Persistent Skin Lesion in a Patient with Ulcerative Colitis

Abstract

Immunosuppressive drugs are commonly used for the treatment of inflammatory bowel disease. Patients receiving immunosuppressants are susceptible to a variety of infections with opportunistic pathogens. We present a case of skin infection with Mycobacterium chelonae in a 60-year-old Caucasian woman with ulcerative colitis who had been treated with corticosteroids and azathioprine. The disease manifested with fever and rash involving the right leg. Infliximab was administered due to a presumptive diagnosis of pyoderma gangrenosum, leading to worsening of the clinical syndrome and admission to our hospital. Routine cultures from various sites were all negative. However, Ziehl-Neelsen staining of pus from the lesions revealed acid-fast bacilli, and culture yielded a rapidly growing mycobacterium further identified as M. chelonae. The patient responded to a clarithromycin-based regimen. Clinicians should be aware of skin lesions caused by atypical mycobacteria in immunocompromised patients with inflammatory bowel disease. Furthermore, they should be able to thoroughly investigate and promptly treat these conditions.

Nontuberculous mycobacterial infection of the musculoskeletal system in immunocompetent hosts

“…If there is no growth on culture but diagnosis of NTM is suspected based on clinical history and histopathology findings (as in cases A2 and B2), treatment has to be started on the basis of the susceptibility results published in the literature 31. Agents which can be used for treating NTM infections are macrolides (clarithromycin, azithromycin); rifampin or rifabutin; ethambutol; doxycycline; quinolones (ciprofloxacin, moxifloxacin, and gatifloxacin); sulfonamides; amikacin; streptomycin; isoniazid; ethionamide; cefmetazole; and imipenem 34. The number of agents required for effective treatment is not clear, although three drug regimens are often adopted 4.…”

“…31 Agents which can be used for treating NTM infections are macrolides (clarithromycin, azithromycin); rifampin or rifabutin; ethambutol; doxycycline; quinolones (ciprofloxacin, moxifloxacin, and gatifloxacin); sulfonamides; amikacin; streptomycin; isoniazid; ethionamide; cefmetazole; and imipenem. 34 The number of agents required for effective treatment is not clear, although three drug regimens are often adopted. 4 For most NTM infections, macrolide-based drug regimens are an effective option.…”

Mycobacterium chelonae cutaneous infection in a patient with mixed connective tissue disease

“…However, immunosuppressive status (transplant recipients; those with AIDS; immunosuppressive drug use, and long term corticotherapy) have led to infections, caused by these organisms in humans since the 1950s. 3 , 4 It has also been recognized that this kind of infection may appear in non-immunocompromised people, but also in those with lung base disease or those who have undergone some invasive procedure, as the simple act of shaving or major operations, due to a residual break in the skin or potentially contaminated instruments. 5…”

Pyoderma Gangrenosum: A Current Problem as Much as an Unknown One

“…Other conditions that may share similar clinical features with PG are vasculitis such as Wegener’s granulomatosis, 77,78 Behçet’s disease 67,79 and antiphospholipid syndrome 80,81 ; apart from these, there are skin cancer manifestations, including squamous cell carcinoma, 82 cutaneous lymphoma, 83,84 and metastatic carcinoma. Moreover, even many infectious diseases such as cellulitis, necrotizing fasciitis, 85,86 herpetic ulcers, 87,88 atypical mycobacterial infections, 89 cutaneous tuberculosis, 90 leishmaniasis, sporotrichosis, 91 cryptococcosis, 92,93 histoplasmosis, 94,95 mucormycosis, 96 blastomycosis, 97 and ecthyma gangrenosum 98 have to be considered. Finally, it is important to mention factitious skin ulcers, 99 which belong to Munchausen syndrome, iatrogenic ulcers caused by drug injections and bites of spiders or other insects.…”