title: Mycobacterium haemophilum infection with prominent facial manifestation mimicking leprosy.
abstract: Mycobacterium haemophilum is a slow-growing non-tuberculous mycobacterium that is rarely known to cause human skin infection, particularly in immunocompromised patients. We recently experienced a 69-year-old Japanese woman with this infection who had been under immunosuppressive treatment for recalcitrant rheumatoid arthritis. The patient showed disseminated erythematous plaques and subcutaneous nodules on the face and extremities, and interestingly, the face manifested with a striking "facies leontina" appearance. Biopsy revealed abscess and granulomatous dermatitis with the involvement of peripheral nerve bundles and the presence of innumerable acid-fast bacilli, thus necessitating differentiation from lepromatous leprosy. M. haemophilum was identified by molecular characterization as well as by successful culture with iron supplements. Although drug susceptibility testing indicated responsiveness to multiple antibiotics administrated simultaneously for the treatment, it took over 6 months to achieve significant improvement, and we also employed concurrent oral potassium iodide administration and repeated surgical excision. This case highlights the importance of continuous combination therapy for successful outcome in this rare infection. Furthermore, application of potassium iodide for mycobacterial infection warrants further evaluation by accumulating more cases.
authors.affiliation: Department of Dermatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ishii
authors.affiliation: Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan.
authors.forename: Norihisa
authors.initials: N
authors.lastname: Ishii
authors.affiliation: Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan.
authors.forename: Kazue
authors.initials: K
authors.lastname: Nakanaga
authors.affiliation: Department of Clinical Laboratory, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Nakano
authors.affiliation: Department of Pathology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Saito
authors.affiliation: Department of Dermatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.|Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Asahina
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D005145:Face / Q000473:pathology; D005260:Female; D006801:Humans; D007918:Leprosy / Q000175:diagnosis*; D009164:Mycobacterium Infections / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D018393:Mycobacterium haemophilum / Q000302:isolation & purification*
keywords: Mycobacterium haemophilum; immunosuppression; leprosy; potassium iodide; treatment