title: [Cutaneous non-tuberculous mycobacterial infection following cord blood stem cell transplantation].
abstract: 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.
authors.affiliation: Department of Pediatrics, Yokohama City University School of Medicine.
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Yanagimachi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Goto
authors.forename: Tomoko
authors.initials: T
authors.lastname: Yokosuka
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Kajiwara
authors.forename: Hisaki
authors.initials: H
authors.lastname: Fujii
authors.forename: Fumiko
authors.initials: F
authors.lastname: Kuroki
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ito
authors.forename: Shumpei
authors.initials: S
authors.lastname: Yokota
authors.forename: Aiko
authors.initials: A
authors.lastname: Taniguchi
authors.forename: Yuki
authors.initials: Y
authors.lastname: Shigehira
authors.forename: Zenro
authors.initials: Z
authors.lastname: Ikezawa
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Inayama
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D000583:Amikacin; D017291:Clarithromycin