[Cutaneous non-tuberculous mycobacterial infection following cord blood stem cell transplantation].
We describe a 4-year-old-girl with familial hemophagocytic lymphohistiocytosis (FHL) who developed disseminated cutaneous nontuberculous mycobacterial (NTM) infection after unrelated cord blood stem cell transplantation (uCBSCT). After transplantation, the patient developed steroid-refractory acute graft-versus-host disease, and was given methylprednisolone, cyclosporin and mycophenolate mofetil. Six months after uCBSCT, cutaneous lesions that looked like insect bites appeared and spread widely over the thighs. NTM infection was diagnosed by skin biopsy although no organism could be identified. Minocycline (MINO) and sulfamethoxazole/trimethoprim (ST) were administered. However, the cutaneous disease followed a course of remissions and exacerbations. One month after the skin biopsy, mycobacterium chelonae was detected by bacteriological culture of abscess drainage. Ten months after uCBSCT, the cutaneous lesions quickly progressed and the inguinal lymph nodes became enlarged and painful. Then the antibiotics were switched from MINO and ST to amikacin and clarithromycin (CAM) based on the results of mycobacterial susceptibility test. The cutaneous lesions gradually improved after continuous administration of CAM. Cutaneous NTM infection is rare, but it may occur in immunocompromised patients after SCT.
Yanagimachi
Masakatsu
M
Department of Pediatrics, Yokohama City University School of Medicine.
Goto
Hiroaki
H
Yokosuka
Tomoko
T
Kajiwara
Ryosuke
R
Fujii
Hisaki
H
Kuroki
Fumiko
F
Ito
Shuichi
S
Yokota
Shumpei
S
Taniguchi
Aiko
A
Shigehira
Yuki
Y
Ikezawa
Zenro
Z
Inayama
Yoshiaki
Y
D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D017291:Clarithromycin / Q000627:therapeutic use; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D051359:Lymphohistiocytosis, Hemophagocytic / Q000628:therapy*; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D016926:Mycobacterium chelonae; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000583:Amikacin; D017291:Clarithromycin