Skin Lesions Caused by Mycobacterium scrofulaceum

Abstract

A 32-year-old man with systemic lupus erythematosus controlled by steroid therapy developed multifocal cutaneous abscesses caused by Mycobacterium scrofulaceum. The distribution and evolution of the lesions suggested hematogenous dissemination, but he exhibited no pulmonary or other visceral manifestations of systemic mycobacterial disease. The patient completed nine months of therapy with isoniazid and rifampin, and the lesions resolved within five months of presentation.

Epithelioid Histiocytic Infiltrate Caused by Mycobacterium scrofulaceum Infection

“…Cutaneous infections by M. scrofulaceum is relatively rare but has been reported. [3][4][5][6][7][8] Cutaneous infection by M. scrofulaceum can take on many clinical appearances such as a nodule, abscess, plaque, or ulcerated lesion (Table 1). 3 Three cases 4,6,8 were associated immunosuppression, and 2 cases were associated with previous trauma to the skin.…”

“…3 Most of the lesions were solitary, 3-5 whereas 2 cases had multiple lesions. 6,7 The site of predominance was the arm or hands 4,5,7 of adults or elderly persons. Coinfection was seen in one case with Mycobacterium peregrinum.…”

“…13 Successful treatment often requires duration of 4-6 months. 3 For M. scrofulaceum in particular, regimens including isoniazid, ethambutol, rifampin, and ofloxacin 14 ; azithromycin and rifampin 4 ; sparfloxacin and minocycline 5 ; and isoniazid and rifampin 6 have been used. Clarithromycin (500 mg bid) monotherapy has also shown promise in effective treatment of this organism as in our case.…”

Successful Treatment of Localized Cutaneous Infection Caused by Mycobacterium scrofulaceum with Clarithromycin

“…The optimal treatment for M. scrofulaceum infection is unknown. Cutaneous infection was treated with combinations of isoniazid, ethambutol, rifampin, and ofloxacin (7), azithromycin and rifampin (10), sparfloxacin and minocycline (11), and isoniazid and rifampin (12). Recently, clarithromycin has been reported to be a promising drug for the treatment of patients with NTM skin infections.…”

Therapy of nontuberculous mycobacterial infections

“…Murray‐Leisure et al. reported multiple cutaneous nodules and ulcerating abscesses in a 32‐year‐old campground worker on steroid therapy for systemic lupus erythematosus (25). In 1972, Sowers described a case of sporotrichoid infection in an elderly patient, analogous to the “swimming pool granuloma” caused by M. marinum (26).…”