Disseminated Mycobacterium marinum infection with extensive cutaneous eruption and bacteremia in an immunocompromised patient.
Mycobacterium marinum can cause fish tank granuloma (or swimming pool or aquarium granuloma) in immunocompetent patients. Dissemination of Mycobacterium marinum-infection is a rare condition which occurs mainly in immunocompromised patients and can be life-threatening. We report the case of an 87-year-old woman who was treated with oral corticosteroids for polymyalgia rheumatica for many years and developed erythema nodosum-like lesions on the right forearm and arthritis of the right wrist. By increasing the steroid dosage and adding methotrexate only short-term remission was achieved. Seven months later painful erythematous nodules occurred on all extremities which became necrotic, ulcerative and suppurative. Ziehl-Neelsen staining revealed acid-fast bacilli and Mycobacterium marinum was cultured from skin biopsies, blood, and urine. The critically ill patient was treated with clarithromycin and ethambutol resulting in a dramatic improvement of the general condition. After four months, doxycycline had to be added because of new skin lesions. This case illustrates the impact of Mycobacterium marinum infection in immunocompromised patients.
Streit
Markus
M
Department of Dermatology, Inselspital, University of Bern, 3010 Bern, Switzerland. markus.streit@insel.ch
Böhlen
Lorenz M
LM
Hunziker
Thomas
T
Zimmerli
Stefan
S
Tscharner
Gion G
GG
Nievergelt
Helga
H
Bodmer
Thomas
T
Braathen
Lasse R
LR
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology* / Q000503:physiopathology; D016638:Critical Illness; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology; D019910:Mycobacterium marinum / Q000302:isolation & purification*; D011111:Polymyalgia Rheumatica / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D018570:Risk Assessment; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents; D007166:Immunosuppressive Agents