title: Synchronous infection with Mycobacterium chelonae and Paecilomyces in a heart transplant patient.
abstract: A 41-year-old male who was 3 years status post heart transplant presented with a 3-month history of painful erythematous nodules and ulcers on his lower legs and right hand. First, Mycobacterium chelonae infection was revealed through several biopsies with molecular sequence analysis, and combination treatment, including clarithromycin, was started. During the treatment, lesions of the legs showed an improvement, but a fluctuant erythematous nodule on the thumb did not respond. Repetitive biopsy from the thumb ultimately identified Paecilomyces species and the patient was treated with itraconazole and terbinafine sequentially. Our case is the first report, to our knowledge, of synchronous infection with non-tuberculous mycobacteria (NTM) and Paecilomyces in a solid organ transplant recipient. Our findings highlight the importance of recognizing cutaneous NTM infections or deep mycoses, as well as the importance of choosing an appropriate treatment.
authors.affiliation: Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: J-E
authors.initials: JE
authors.lastname: Kim
authors.forename: H
authors.initials: H
authors.lastname: Sung
authors.forename: M-N
authors.initials: MN
authors.lastname: Kim
authors.forename: C-H
authors.initials: CH
authors.lastname: Won
authors.forename: S-E
authors.initials: SE
authors.lastname: Chang
authors.forename: M-W
authors.initials: MW
authors.lastname: Lee
authors.forename: J-H
authors.initials: JH
authors.lastname: Choi
authors.forename: K-C
authors.initials: KC
authors.lastname: Moon
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001706:Biopsy; D017291:Clarithromycin / Q000627:therapeutic use; D003881:Dermatomycoses / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D004359:Drug Therapy, Combination; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D007866:Leg / Q000382:microbiology / Q000473:pathology; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D016926:Mycobacterium chelonae / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D010143:Paecilomyces / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D017192:Skin Diseases, Bacterial / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D013933:Thumb / Q000382:microbiology / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D017964:Itraconazole; D017291:Clarithromycin