Explosive generalization of nodular vasculitis – <i>Mycobacterium marinum</i> challenges the paradigm

Papathemeli, Despoina; Franke, Ingolf; Bonnekoh, Bernd; Gollnick, Harald; Ambach, Andreas

doi:10.1111/jdv.13498

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…The patients received Etanercept and Adalimumab [25,26]. In the majority of published cases, a combination therapy with a cDMARD and a bDMARD was present [27][28][29]. In one published case a combination of two cDMARDs and one bDMARD was described [30].…”

Section: Discussionmentioning

confidence: 99%

Flare or foe? - Mycobacterium marinum infection mimicking rheumatoid arthritis tenosynovitis: case report and literature review

et al. 2020

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Background: Rheumatoid arthritis is the most common type of inflammatory arthritis affecting about 1% of the population. With the advent of disease-modifying anti-rheumatic drugs the disease can be well controlled in many cases. Patients, however, are prone to developing infectious complications. In rare cases, these can mimic a flare of the underlying itself. Case presentation: We report the case of a 45-year-old female patient with a history of seronegative rheumatoid arthritis (RA) who presented with swelling and tenderness of the third metacarpophalangeal joint of the right hand. A flare of her RA was suspected based on clinical and ultrasound findings which showed a tenosynovitis with intense power doppler activity. Her steroid dose was increased but the clinical response to glucocorticoid therapy was very limited. Subsequently, she developed skin manifestations of 'swimmer's granuloma' over the next 2 weeks after first presentation. Finally, a diagnosis of a Mycobacterium marinum infection was established with the help of tissue biopsy and culture, and the patient received appropriate antibiotic treatment with the desired effect. Conclusions: This case highlights the difficulty of distinction between infection and inflammation in patients with joint swelling and pain, especially in the age of disease-modifying drugs (DMARDs) and the concomitant risk of atypical infections. A review of the literature identified eight additional published cases, which suggests that Mycobacterium marinum infection is a rare but recognized complication of DMARD therapy. It can mimic a flare of the underlying arthritis potentially leading to diagnostic delays, and requires differential diagnostic methods to identify the pathogen and pave the way for appropriate treatment.

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Section: Discussionmentioning

confidence: 99%

Flare or foe? - Mycobacterium marinum infection mimicking rheumatoid arthritis tenosynovitis: case report and literature review

et al. 2020

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“…Ziehl-Neelsen staining for acid-fast bacilli and mycobacterial culture usually result negative [64,65]. However, there is one report in which M. marinum was isolated [66]. The most striking features of EI are strongly positive tuberculin purified protein derivative (PPD) with an induration greater than 20 mm and clearance of skin lesions with anti-tuberculosis therapy, which occurs within 1-6 months (mean, 2.1 months).…”

Section: Primarily-lobular Panniculitides With Vasculitismentioning

confidence: 99%

Panniculitides of particular interest to the rheumatologist

Morita

Trés

García³

et al. 2019

Adv Rheumatol

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The panniculitides remain as one of the most challenging areas for clinicians, as they comprise a heterogeneous group of inflammatory diseases involving the subcutaneous fat with potentially-shared clinical and histopathological features. Clinically, most panniculitides present as red edematous nodules or plaques. Therefore, in addition to a detailed clinical history, a large scalpel biopsy of a recent-stage lesion with adequate representation of the subcutaneous tissue is essential to specific diagnosis and appropriate clinical management. Herein we review the panniculitides of particular interest to the rheumatologist.

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