Affiliation:
1. Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, P.R. China.
Abstract
Rationale:
Mycobacterium haemophilum is a rare pathogen, belongs to the slowly-growing nontuberculous mycobacterium family, and shares a close evolutionary relationship with Mycobacterium leprae. It is a fastidious organism that requires special media(iron or hemin supplementation)and conditions (incubation at 30–32°C) for growth, which differs from most other pathogenic mycobacteria.
Patient concerns:
A 43-year-old Asian male presented to our outpatient department due to the appearance of multiple infiltrative erythematous nodules and ulcerations on the extremities for more than 2 months.
Diagnoses:
Acid-fast bacteria were detected in the specimen and sequencing for hsp65 and 16S rRNA genes of the pathogen extracted from the biopsy tissue identified as M haemophilum. The diagnosis of cutaneous M haemophilum infection was established.
Interventions:
The patient received a 3-drug regimen (oral clarithromycin 1.0 g/d, rifampicin 0.6 g/d, and moxifloxacin 1.0 g/d) and local hot compression therapy, the dose of immunosuppressant was reduced.
Outcomes:
The lesions gradually improved after 6 months of continuous antibiotic therapy. There is no recurrence of erythema papules and nodules.
Lessons:
This case shows that the patient’s condition may be exacerbated immediately after the initiation of anti-nontuberculous mycobacterium therapy, which is analogous to the leprosy reaction. A high degree of clinical suspicion for the underlying disease is critical to avoid unnecessary interruption of treatment.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
General Earth and Planetary Sciences,General Environmental Science