Abstract
Patients who suffer from rare skin diseases may try numerous therapies with many potential side effects before achieving remission. Livedoid vasculopathy (LV) is one such rare disease that lacks a definitive treatment as evidenced by randomized controlled trials. Although corticosteroids help reduce the pain flares associated with LV, they come at the risk of immunosuppression. We present a case of disseminated cutaneous infection of M. chelonae/abscessus arising in a diabetic patient on long-term corticosteroid therapy. This patient required an intensive antibiotic regimen and potentially lifelong antibiotic suppression pending improvement of her disseminated cutaneous infection. We report this case to increase awareness of the diagnostic consideration of atypical, rapidly growing mycobacterial (RGM) infection when encountering patients with a diffuse onset of ulcerative skin nodules amid a background of diabetes and long-term corticosteroid use.
Highlights
Livedoid vasculopathy (LV) is a chronic, painful condition that typically a ects the cutaneous vasculature of the distal legs [1].ere is no standard or de nitive treatment of livedoid vasculopathy as evidenced by a randomized controlled trial, perhaps due to its rare incidence at 1 : 100,000 [2]
Case reports and series have demonstrated a multitude of therapeutic options with the most common being anticoagulants, antiplatelet drugs, systemic steroids, and intravenous immunoglobulins (IVIG) [3]. ese therapies each have a wealth of adverse e ects and contraindications that can make it di cult to treat a patient with comorbidities alongside a rare disease such as livedoid vasculopathy
We present a case of disseminated cutaneous infection of M. chelonae/abscessus occurring in a diabetic patient on longterm corticosteroid therapy for her rare livedoid vasculopathy
Summary
Livedoid vasculopathy (LV) is a chronic, painful condition that typically a ects the cutaneous vasculature of the distal legs [1]. Ese therapies each have a wealth of adverse e ects and contraindications that can make it di cult to treat a patient with comorbidities alongside a rare disease such as livedoid vasculopathy. A rare example of this is disseminated cutaneous infection with nontuberculous mycobacterial species such as the Mycobacterium chelonae–abscessus complex. 90% of these disseminated cutaneous infections occurred with corticosteroid therapy, with some underlying conditions including autoimmune disease, renal transplant, and rheumatoid arthritis [7]. A retrospective study in 2016 suggested that so -tissue infection with nontuberculous mycobacterial species were three times overrepresented in diabetic patients when compared to the general population [9]. We present a case of disseminated cutaneous infection of M. chelonae/abscessus occurring in a diabetic patient on longterm corticosteroid therapy for her rare livedoid vasculopathy
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