title: A rare combination of sites of involvement by Mycobacterium intracellulare in a hemodialysis patient: multifocal synovitis, spondylitis, and multiple skin lesions.
abstract: OBJECTIVE
  Atypical mycobacterial infection is a rare but serious hazard in immunocompromised patients including those undergoing maintenance hemodialysis and immunosuppressive therapy. Recognition of unusual involvement patterns is important.
  
  
  METHODS
  We describe an extremely rare combination of complications caused by such an organism in a patient with end-stage renal disease: spinal osteolysis and multiple skin lesions associated with synovitis.
  
  
  RESULTS
  The patient had received a renal allograft 18 years previously but developed infection with Mycobacterium avium-M. intracellulare complex including dermatologic manifestations, spondylitis, and synovitis involving the wrist and lateral malleolus after initiation of hemodialysis when the transplanted kidney failed. An empirical antibiotic regimen failed to alleviate skin lesions or fevers, or to lower an elevated C-reactive protein concentration, until the patient's dose of methylprednisolone was increased to treat mild adrenal insufficiency. The increase resulted in rapid resolution of skin lesions. A compression fracture 6 months later was attributed to spondylitis caused by the same organism.
  
  
  CONCLUSIONS
  We suspect that spondylitis represented the primary focus of M. intracellulare infection.
authors.affiliation: Department of Kidney and Dialysis, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Yoshinaga
authors.initials: Y
authors.lastname: Otaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakanishi
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nanami
authors.forename: Masayo
authors.initials: M
authors.lastname: Aizawa
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Yanase
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hiraoka
authors.forename: Masaaki
authors.initials: M
authors.lastname: Izumi
authors.forename: Toru
authors.initials: T
authors.lastname: Inoue
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Takamitu
authors.forename: Akira
authors.initials: A
authors.lastname: Arakawa
authors.forename: Masaru
authors.initials: M
authors.lastname: Adachi
authors.forename: Souji
authors.initials: S
authors.lastname: Maruo
mesh_terms: D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D015269:Mycobacterium avium Complex; D006435:Renal Dialysis; D013166:Spondylitis / Q000382:microbiology; D013585:Synovitis / Q000382:microbiology; D014382:Tuberculosis, Cutaneous / Q000150:complications* / Q000473:pathology; D014394:Tuberculosis, Osteoarticular / Q000150:complications* / Q000473:pathology; D014399:Tuberculosis, Spinal / Q000150:complications* / Q000473:pathology