Atypical Mycobacterial Infection Presenting as Persistent Skin Lesion in a Patient with Ulcerative Colitis

Giorgos Bamias,Spiros D Ladas,Garyfallia Kaltsa,Spyros I Siakavellas,Stavroula Smilakou,Ioannis Katsogridakis,George L Daikos,Irene Vafiadis-Zouboulis

doi:10.1155/2011/480987

Abstract

Immunosuppressive drugs are commonly used for the treatment of inflammatory bowel disease. Patients receiving immunosuppressants are susceptible to a variety of infections with opportunistic pathogens. We present a case of skin infection with Mycobacterium chelonae in a 60-year-old Caucasian woman with ulcerative colitis who had been treated with corticosteroids and azathioprine. The disease manifested with fever and rash involving the right leg. Infliximab was administered due to a presumptive diagnosis of pyoderma gangrenosum, leading to worsening of the clinical syndrome and admission to our hospital. Routine cultures from various sites were all negative. However, Ziehl-Neelsen staining of pus from the lesions revealed acid-fast bacilli, and culture yielded a rapidly growing mycobacterium further identified as M. chelonae. The patient responded to a clarithromycin-based regimen. Clinicians should be aware of skin lesions caused by atypical mycobacteria in immunocompromised patients with inflammatory bowel disease. Furthermore, they should be able to thoroughly investigate and promptly treat these conditions.

Highlights

Immunosuppressive drugs, consisting of corticosteroids, immunomodulators, and biological factors, are the mainstay of treatment for inflammatory bowel disease (IBD)
Patients receiving immunosuppressants become susceptible to infections, caused by common pathogens, and, by various opportunistic microorganisms. The latter may cause unusual clinical syndromes, generating diagnostic and therapeutic challenges, as they are confused with the variety of extraintestinal manifestations of Ulcerative Colitis (UC) and Crohn’s disease (CD) [2]
We describe a case of skin infection with Mycobacterium chelonae in a woman who was under long-term immunosuppressive treatment for UC

Summary

Introduction

Immunosuppressive drugs, consisting of corticosteroids, immunomodulators, and biological factors, are the mainstay of treatment for inflammatory bowel disease (IBD). These medications lead to a state of immunosuppression, the severity of which depends upon the specific drug, the dose administered, and the duration of treatment [1]. Patients receiving immunosuppressants become susceptible to infections, caused by common pathogens, and, by various opportunistic microorganisms. The latter may cause unusual clinical syndromes, generating diagnostic and therapeutic challenges, as they are confused with the variety of extraintestinal manifestations of Ulcerative Colitis (UC) and Crohn’s disease (CD) [2]. The final diagnosis was achieved only when microbiological testing with optimal culture conditions was applied

Case Presentation

Discussion

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Conclusion