title: Atypical mycobacteria infection in an immunocompromised patient.
abstract: A 61-year-old woman with systemic lupus erythematosus and Sjögren syndrome presented with a two-month history of symptomatic nodules on the buttocks and thighs that progressed to involve the dorsal aspects of the hands. On examination, infiltrative papules, nodules, and plaques were present in these regions. Biopsy specimens demonstrated granulomatous inflammation and acid-fast bacilli with the use of a Fite stain, although a culture and polymerase chain reaction analysis were negative. The patient continues to improve on long-term clarithromycin therapy. Atypical mycobacterial infections are becoming more common, especially in immunocompromised patients. Antimicrobial therapy, either with a single agent or multiple agents, often is prolonged. A high index of suspicion is warranted in immunocompromised patients, which includes those with connective-tissue diseases that are active or that require immunosuppression. In these patients, the differential diagnosis includes infectious as well as inflammatory, reactive, or neoplastic processes.
authors.affiliation: Department of Dermatology, New York University, New York, NY, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Berger
authors.forename: Priya
authors.initials: P
authors.lastname: Batra
authors.forename: Jonathan
authors.initials: J
authors.lastname: Ralston
authors.forename: Miguel R
authors.initials: MR
authors.lastname: Sanchez
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Franks
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D002081:Buttocks / Q000473:pathology; D017291:Clarithromycin / Q000627:therapeutic use; D005260:Female; D006225:Hand / Q000473:pathology; D006801:Humans; D016867:Immunocompromised Host; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000276:immunology; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D012859:Sjogren's Syndrome / Q000150:complications / Q000276:immunology; D012871:Skin Diseases / Q000175:diagnosis* / Q000188:drug therapy; D013848:Thigh / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017291:Clarithromycin