A Case of Cutaneous Mycobacterium Chelonae
Abscessus Infection in a Renal Transplant Patient |
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Authors: | Carin H Endzweig Eric Strauss Frank Murphy Babar K Rao |
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Institution: | (1) Department of Dermatology, New York Presbyterian Hospital-Cornell University Medical College, New York, New York, USA, US;(2) Department of Dermatology, Robert Wood Johnson Medical Center, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA, US |
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Abstract: | Abstract
Background: Mycobacterium chelonae is an atypical "fast-growing Mycobacteria" that is a rare cause of human infection. There
have been several reports of cutaneous infection among immunosuppressed patients, as well as in immunocompetent individuals
following trauma. Most cases to date seem to have occurred among renal transplant recipients, raising the possibility that
there is something inherent to the renal transplant patient that increases their susceptibility more than other immunocompromised
patients. Objective: The differential diagnosis of subcutaneous nodules distributed in a sporotrichoid pattern is extensive,
particularly in an immunocompromised host. Although several cases of cutaneous M. chelonae abscessus infection have been reported
among both immunosuppressed and immunocompetent patients, the clinical presentation has varied, and few cases have reported
the appearance of lesions in a sporotrichoid pattern. We present a case of a renal transplant patient with a reported history
of trauma to the lower extremities, who presents with subcutaneous nodules distributed in a sporotrichoid pattern. The patient
is found to have M. chelonae abscessus infection, fails several treatment regimens, and presents with a recurrence. The literature
of M. chelonae infection is reviewed, and the various treatment options are discussed. Methods: An initial skin biopsy was
stained with Hematoxylin and Eosin and revealed deep dermal abscesses with acid-fast bacilli in clusters. The culture became
positive for Mycobacterium chelonae abscesses in four days and was found to be sensitive to multiple antibiotics. The patient
underwent surgical excision of 14 nodules, which revealed findings consistent with the skin biopsy, and was subsequently treated
with the appropriate antibiotics. Results: Despite treatment with a full course of an organism-sensitive antibiotic regimen,
the patient returned with persistent and recurrent nodules six weeks later. The patient was then treated as an inpatient with
a seven-week course of intravenous antibiotics and was discharged home on a combined intravenous and oral regimen. Conclusion:
Although M. chelonae abscessus is an extremely rare cause of infection among humans, there seems to be a predominance of cases
reported among renal transplant patients. The explanation for this is not entirely clear; however, the organism must be considered
as a cause of infection in any renal transplant recipient who presents with subcutaneous nodules. Eradication of the organism
presents a tremendous challenge to the clinician, and, as presented here, even with appropriate antibiotics, there is a high
rate of recurrence. |
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