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Early effective treatment of cutaneous infection with Mycobacterium chelonae complex after rapid molecular identification

Abstract number: 1733_1117

Hopman J., Langewouters A., Kroese T., Sturm P.D.J.

Objectives: Slow-growing as well as rapid-growing Mycobacteria can cause cutaneous infection. The latter specifically in immunocompromised patients. The clinical diagnosis may be delayed due to recurrent skin lesions. Rapid diagnosis and identification aids in the initiation of appropriate therapy.

Methods and Results: A 50 y.o. male patient had received a renal transplant 10 years ago for which he used azathioprine and prednison. He presented to a dermatologist with a 2 month history of recurrent skin lesions on his right lower leg and pain of his right foot. A diagnosis of gout was suspected and allopurinol was administered. After a few days, brownish nodules appeared on the right leg which eventually ulcerated with purulent discharge. Subsequently, the lesions healed slowly, leaving behind violaceous maculae with crusts. Flucloxacillin and clindamycin respectively were started empirically with improvement of the skin lesions. New purulent nodules developed after cessation of therapy. Now, a clinical diagnosis of pyoderma gangrenosum was considered which was confirmed histologically. However, prednison improved symptoms only temporarily. Histological examination of new skin biopsies showed acid-fast bacilli. Meanwhile the foot was swollen with increased redness and tenderness and an abscess was suspected. Acid fast staining of surgically drained pus showed numerous PMNs and AFBs. A molecular identification of M. chelonae complex was available within 48 hours and treatment could be initiated with clarithromycin. Amikacin was not considered an option with respect to his renal function and tigecycline was added as second agent.

Conclusion: Spontaneously resolving lesions have been described previously in cutaneous mycobacterial infection and unfamiliarity with this clinical presentation may result in a delayed diagnosis. Because a rapid identification was established with molecular methods, effective antimicrobial therapy could be started early. Newer drugs, such as tigecycline and linezolid, with in-vitro activity against rapid-growing mycobacteria may be useful in future treatment of these infections.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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