title: Skin and joint infection by Mycobacterium chelonae: rescue treatment with interferon gamma.
abstract: BACKGROUND
  Atypical mycobacteria are environmental organisms that cause opportunistic infections in humans.
  
  
  METHODS
  A 50-year-old electronics engineer sought advice about starting TNFalpha antagonist therapy for ankylosing spondylitis. Disease duration was 23 years and current treatment was methylprednisolone 4 mg/d. Atypical skin lesions and knee arthritis were noted. Fluid aspirated from the knee showed inflammatory properties and a few acid-fast bacteria, which a line probe assay identified as Mycobacterium chelonae. The same organism was found in a skin biopsy from a thigh lesion. Antimicrobial treatment was started immediately. Inadequate results 6 months later prompted synovectomy of the knee followed by interferon gamma, 50 microg/m(2) body surface area subcutaneously 3 times a week. After 16 months, there were no new skin or joint lesions, and the antimicrobials and interferon gamma were therefore discontinued.
  
  
  CONCLUSIONS
  This highly unusual case suggests that interferon gamma may be effective in patients with M. chelonae infection that fails to respond adequately to antimicrobials.
authors.affiliation: Rheumatology Department, Brest Teaching Hospital, Brest, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Jousse-Joulin
authors.forename: Michel
authors.initials: M
authors.lastname: Garre
authors.forename: Xavier
authors.initials: X
authors.lastname: Guennoc
authors.forename: Claire
authors.initials: C
authors.lastname: Destombe
authors.forename: Isabelle
authors.initials: I
authors.lastname: Samjee
authors.forename: Valérie
authors.initials: V
authors.lastname: Devauchelle-Pensec
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
mesh_terms: D016918:Arthritis, Reactive / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007371:Interferon-gamma / Q000627:therapeutic use*; D007719:Knee Joint; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis* / Q000188:drug therapy*; D016926:Mycobacterium chelonae / Q000302:isolation & purification*; D019637:Orthopedic Procedures; D018570:Risk Assessment; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000188:drug therapy*; D013167:Spondylitis, Ankylosing / Q000175:diagnosis / Q000188:drug therapy; D017211:Treatment Failure
chemical_list: D007371:Interferon-gamma; D008775:Methylprednisolone