Cutaneous manifestations of atypical mycobacterium chelonae: A case report

Summary: Abstract Body: Patient history: A 39 year old Native Hawaiian man was admitted to inpatient care for multiple cutaneous nodules and ulcers of the face and all extremities and gangrene of the toes. His medical history included congestive heart failure (CHF) from nonischemic congenital cardiomyopathy, ventricular tachycardia with an implantable defibrillator. Biopsies: Punch biopsy of a nodule on the right forearm showed positive acid-fast bacilli (AFB) in a pan-dermal, granulomatous and focally neutrophilic infiltrate. Laboratory Data: PCR results did not return until 48 days after collection due to delayed processing. PCR of the right forearm sample demonstrated Mycobacterium chelonae, abscessus group. Diagnosis: Although he was initially suspected to have cutaneous dissemination related to a Staphylococcus Aureus from his implanted defibrillator, the patient was found to have disseminated Mycobacterium chelonae infection, which rarely affects humans. Here, it manifested in a diverse presentation of cutaneous nodules and papular abscesses. This appears to be increasingly prevalent in the last decade. Treatment: The causative organism was not easily identifiable and the patient was initially treated for bacterial sepsis. Initial treatment included prednisone 20 mg BID resulted in significant immunosuppression. Treatment for suspected Staphylococcus aureus sepsis included multiple courses of antibiotics for vancomycin, ceftriaxone, daptomycin, tigecycline, linezolid, imipenem and amikacin. Because tissue culture and PCR confirmation took several weeks, there was delayed identification and treatment of M. chelonae. Although the nodules began to respond to appropriate treatment with minocycline, azithromycin and tigecycline the patient’s condition was compromised by CHF and he expired. The state of Hawaii as well as the field of dermatology are both experiencing physician shortages, which has led to poor dermatologic access in the region [1]. This demonstrates multiple cutaneous manifestations of systemic AFB infection. Katelyn S. Stenger¹, Heather S. Zimmerman¹, Ralina Karagenova¹, David Elpern², Douglas Johnson¹ 1. John A. Burns School of Medicine, University of Hawai'i System, Honolulu, HI, United States. 2. The Skin Clinic, Williamstown, MA, United States. Minoritized Populations and Health Disparities Research