Cutaneous Mycobacterium Chelonae Infection in a Heart Transplant Recipient

Abstract

<h3>Introduction</h3> Mycobacterium Chelonae (MC) is a rapid grower of non Tuberculous Mycobacterium. It is rarely reported in heart transplant recipients. Here, we present a case of MC cutaneous infection in a heart transplant recipient. <h3>Case Report</h3> A 53-year-old male presented with a 3-month history of painful itchy discoid lesions, with the largest on the ulnar aspect of his right arm. One month prior, he underwent heart transplantation following an inpatient 6 month stay. On examination, multiple raised erythematous lesions with firm consistency were noted over the hand, wrist, and forearm. A skin biopsy was taken. MC was identified by whole genome sequencing. He was initiated on 4 weeks of intravenous imipenem and tobramycin with oral clarithromycin followed by oral azithromycin, clofazimine and linezolid for another 6 months with reduction in pain and lesion size. <h3>Summary</h3> Only 4 previous cases of MC following heart transplantation have been reported in the literature over the last 15 years. Our review was conducted using PubMed, MEDLINE, EMBASE. Cutaneous manifestation of MC is described as pigmented papules, nodules and granulomas, commonly found on the extremities. These can progress to pustules, haemorrhagic crusts and abscesses. In retrospect, the lesions seen in this case are typical of this presentation, but this was not clinically suspected. Diagnosis was ultimately made based on skin biopsy. These rapidly growing mycobacteria are resistant to the usual antituberculous drugs and can be associated with life-threatening complications such as mediastinitis and pulmonary infections. Reduction in immunosuppression was limited due to the early post transplant presentation in this case, however MC is reported up to 3 years post-transplant. There is no robust trial data regarding treatment of this organism, therefore early recognition of the presentation is crucial. In our case, early dermatology review facilitated prompt diagnosis and multidisciplinary approach to treatment resulted in a good outcome for the patient.