[Skin nodules and ulcers of the limbs in a patient with rheumatoid arthritis].
METHODS
While being treated with corticosteroids and methotrexate for rheumatoid arthritis, a 63-year-old man developed livid nodules on his lower arms, hands and feet, as well as fever, necrotizing skin ulcers and rupture of a finger extensor tendon.


METHODS
No vasculitis was found in a biopsy of one of the nodules on the lower arm. Fast growing mycobacteria, classified as M. marinum by PCR, were cultured from wound swabs.


METHODS
The lesions healed on administration of ciprofloxacin, ethambutol and clarithromycin as well as local treatment.


CONCLUSIONS
Cutaneous lesions of an atypical mycobacterial infection are often misdiagnosed. This is especially so in immunocompromised patients and in the differential diagnosis of vasculitis.
Böcher
W
W
I. Medizinische Klinik und Poliklinik der Johannes Gutenberg-Universität Mainz, Germany.
Galle
P R
PR
Märker-Hermann
E
E
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D001706:Biopsy; D002939:Ciprofloxacin / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000627:therapeutic use; D005121:Extremities; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D019910:Mycobacterium marinum / Q000302:isolation & purification*; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D012883:Skin Ulcer / Q000188:drug therapy / Q000382:microbiology*; D014657:Vasculitis / Q000175:diagnosis
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D018501:Antirheumatic Agents; D000995:Antitubercular Agents; D005938:Glucocorticoids; D002939:Ciprofloxacin; D004977:Ethambutol; D011239:Prednisolone; D017291:Clarithromycin; D008727:Methotrexate
Hautknoten und Ulzera der Extremitäten bei einem Patienten mit rheumatoider Arthritis.