Skin and joint infection by Mycobacterium chelonae: rescue treatment with interferon gamma.
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.
Jousse-Joulin
Sandrine
S
Rheumatology Department, Brest Teaching Hospital, Brest, France.
Garre
Michel
M
Guennoc
Xavier
X
Destombe
Claire
C
Samjee
Isabelle
I
Devauchelle-Pensec
Valérie
V
Saraux
Alain
A
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
D007371:Interferon-gamma; D008775:Methylprednisolone