title: [A cutaneous infection by Mycobacterium chelonae in a patient with rheumatoid arthritis].
abstract: There are no pathognomonic findings for cutaneous infection caused by Mycobacterium chelonae. The type and duration of therapy varies considerably among reports and no single antibiotic is considered the treatment of choice. A 61-year-old patient, suffering from rheumatoid arthritis (treated with metotrexate and salazopyrine), presented with violaceous nodules of the right leg that had been evolving for 6 months. She was underwent several skin biopsies. Tissue culture of the last showed an atypical mycobacteria, identified as M. chelonae. Despite improvement after a two-week course of treatment with clarithromycin, a switch to ciprofloxacin was made because of gastrointestinal intolerance. After 3 months, only slight improvement of the lesions was achieved and clarithromycin was reintroduced; significant clinical improvement occurred by the third month. Clarithromycin was continued a further two months until the patient quit on her own and. no recurrence was observed. Infections caused by M. chelonae frequently occur in the setting of immunological impairment. Contaminated water is the natural reservoir, but we were unable to establish the source of contamination. As was previously described, there was a significant delay between clinical presentation and diagnosis. Thus, a high index of suspicion and multiple biopsies with culture are of paramount importance to confirming the diagnosis.
authors.affiliation: Department of Dermatology and Venereology, Hospital de São João EPE, Porto, Portugal. ocsferreira@gmail.com
authors.forename: Olga
authors.initials: O
authors.lastname: Ferreira
authors.forename: Ana Filipa
authors.initials: AF
authors.lastname: Duarte
authors.forename: Teresa
authors.initials: T
authors.lastname: Baudrier
authors.forename: Alberto
authors.initials: A
authors.lastname: Mota
authors.forename: Joana Sobrinho
authors.initials: JS
authors.lastname: Simões
authors.forename: Filomena
authors.initials: F
authors.lastname: Azevedo
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D005944:Glucosamine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007866:Leg; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D016926:Mycobacterium chelonae; D012460:Sulfasalazine / Q000009:adverse effects / Q000627:therapeutic use; D014382:Tuberculosis, Cutaneous / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D007166:Immunosuppressive Agents; C028423:Salazopyrine; D012460:Sulfasalazine; D002939:Ciprofloxacin; D017291:Clarithromycin; D005944:Glucosamine; D008727:Methotrexate