[A case of acute and necrotizing cutaneous Mycobacterium marinum infection in a patient treated with infliximab for Crohn's disease].
BACKGROUND
The increasing use of anti-TNFalpha exposes patients to emerging risks, particularly that of infection. We report a case of severe cutaneous Mycobacterium marinum infection in a patient treated with infliximab and we discuss therapeutic options.


METHODS
A man treated with infliximab for Crohn's disease developed a severe cutaneous infection with M. marinum. Despite withdrawal of infliximab and the introduction of triple antibiotic therapy, the patient's lesions worsened and surgical treatment was required.


CONCLUSIONS
The worsening experienced by our patient 1 week after the beginning of the treatment is comparable with the immune reconstitution syndrome occasionally observed in tuberculosis in immunocompromised hosts, thus raising the question of the potential value of continuing infliximab treatment. Recommendations are needed concerning the prevention and treatment of M. marinum infections in patients on anti-TNFalpha biotherapies.
Guyot
A
A
Service de dermatologie, hôpital Bichat, AP-HP, université Paris-VII, 46, rue Henri-Huchard, 75877 Paris cedex 18, France. alexis.guyot@bch.aphp.fr
Begon
E
E
Abramowitz
L
L
Landry
J
J
Marinho
E
E
Descamps
V
V
Crickx
B
B
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D003424:Crohn Disease / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000139:chemically induced* / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D019910:Mycobacterium marinum; D009336:Necrosis; D017192:Skin Diseases, Bacterial / Q000139:chemically induced / Q000188:drug therapy / Q000601:surgery; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab