title: Mycobacterium chelonae hand infection after steroid injection in a patient with rheumatoid arthritis receiving long-term linezolid therapy.
abstract: A 66-year-old multimorbid man with rheumatoid arthritis developed an infection after a steroid injection in the hand. Mycobacterium chelonae was cultured 1-month after presentation. In the mean time, his third finger had been amputated. Further treatment was based on preliminary susceptibility testing and the American Thoracic Society guidelines. No regression of the infection was observed before the addition of linezolid (600 mg×1/day) to a combination antimicrobial therapy also consisting of clarithromycin (500 mg×2/day) and moxifloxacin (400 mg×1/day), even though two methods of susceptibility testing, the E-test and broth microdilution, had shown susceptibility to other antimicrobial drugs. The healing was complete 12 months after presentation. There were no serious side effects observed with the use of linezolid in reduced dosage of 600 mg×1/day for a duration of 9 months.
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Jens Steen
authors.initials: JS
authors.lastname: Olesen
authors.affiliation: Department of Microbiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Mikala
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.|Department of Public Health, Center for Global Health, Aarhus University, Aarhus, Denmark.
authors.forename: Christian
authors.identifier: http://orcid.org/0000-0002-2534-2942
authors.initials: C
authors.lastname: Wejse
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D024841:Fluoroquinolones / Q000627:therapeutic use; D006225:Hand; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D007270:Injections, Intra-Articular / Q000009:adverse effects*; D000069349:Linezolid / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D000077266:Moxifloxacin; D009165:Mycobacterium Infections, Nontuberculous / Q000209:etiology / Q000628:therapy*; D016926:Mycobacterium chelonae; D013717:Tenosynovitis / Q000628:therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D017291:Clarithromycin; D000069349:Linezolid; D000077266:Moxifloxacin