Disseminated cutaneous infection with Mycobacterium chelonae in a patient with steroid-dependent rheumatoid arthritis.
Mycobacterium chelonae is a rapidly growing atypical mycobacterium that is a normal commensal of water and soil. We report a case of a 61-year-old man with seronegative rheumatoid arthritis and fibrosing alveolitis on long-term prednisolone who presented with a number of tender, red, subcutaneous nodules on his upper arms and a pustule on his left cheek. Histopathologic examination revealed dense neutrophilic collections within the deep dermis and subcutaneous fat with abscess formation. Long filamentous organisms were seen within these collections and were subsequently identified by special stains and PCR as Mycobacterium chelonae. Treatment was not possible as the patient developed bacteria bronchopneumonia before identification of the organism and he subsequently died. Post-mortem revealed no extra-cutaneous evidence of mycobacterium infection.
Lamb
S R
SR
Department of Dermatology, Leeds General Infirmary, Leeds, UK.
Stables
G I
GI
Merchant
W
W
D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D017809:Fatal Outcome; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis* / Q000276:immunology; D016926:Mycobacterium chelonae; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000276:immunology; D011239:Prednisolone / Q000009:adverse effects; D017192:Skin Diseases, Bacterial / Q000175:diagnosis* / Q000276:immunology
D005938:Glucocorticoids; D011239:Prednisolone