Mycobacterium Haemophilum Infection Mimicking Connective Tissue Diseases-A Case Report

Abstract

Mycobacterium haemophilum has recently been recognized as a pathogen in immunocompromised patients. Disease manifestations have been predominantly cutaneous lesions, arthritis and osteomyelitis, but a few cases with lung involvement have been described. A 3-drug regimen that contains a macrolide, a rifampin, and a quinolone was recommended. Moreover, disease caused by this organism has also occurred in some healthy children, where manifestations are cervical, submandibular, and perihilar adenitis, and response to excision of affected lymph nodes only is well. We report a woman with M. haemophilum infection, presenting with Raynaud's phenomenon, cutaneous lesions and autoanti-bodies, and connective tissue diseases were ever considered. The response to corticosteroid was not satisfactory. M. haemophilum was finally identified by polymerase-chain reaction of skin biopsy. Rifampin in combination with ciprofloxacin and clarithromycin were prescribed initially. Doxycyclin and amikacin were added later and debridement of ulcers was undertaken owing to poor response to previous treatment. However, the clinical course was complicated with repeated episodes of sepsis and she succumbed to profound septic shock at the end.