Reactions 1704, p274 - 2 Jun 2018 Mycobacterium haemophilum infection: case report A 75-year-old woman developed Mycobacterium haemophilum infection during treatment with mycophenolate mofetil and prednisolone [dosages, routes and duration of treatment to reaction onset not stated]. The woman, who had type 2 diabetes mellitus and end stage renal disease, received kidney transplantation 18 years previously. She was receiving immunosuppressive treatment with mycophenolate mofetil and prednisolone for years. Six months prior to her current presentation, she sustained a left wrist contusion injury and an unspecified tranditional chinese herbal medicine was applied on the wound. Initially, she had wound swelling with an erythematous base. Subsequently, she developed multiple erythematous papules along the fingers, forearm and face. The papules progressed to become tender nodules, which ruptured with odorous pus leaving behind poor healing ulcers. She was then hospitalised for suspected cellulitis. Subsequent pus cultures yielded non-tuberculous mycobacteria, namely Mycobacterium haemophilum by molecular test. She was then diagnosed with Mycobacterium haemophilum infection. The woman was treated with clarithromycin, rifampicin and moxifloxacin. Her immunosuppressive treatment was changed to low dose prednisolone only with discontinuation of mycophenolate mofetil. However, her antibacterials therapy was adjusted to clarithromycin, ciprofloxacin, rifabutin and doxycycline because of persistent poor wound healing. Subsequently, clarithromycin was discontinued in the second week due to vomiting as a suspected side effect of clarithromycin. Thereafter, tigecycline was added to the antibiotic regimen for secondary wound infection. In addition, wound care was advised with hypochlorous acid and Microdacyn 60. Local debridement was also performed. Following hospitalisation for one month, she had progressive epithelialisation over the skin defects of the left hand. She had no new nodules over the integument. She was then discharged on rifabutin, azithromycin and ciprofloxacin. Following three months of treatment, she had complete resolution of the skin lesion. Author comment: "In immunocompromised host with ulcerating skin lesion, Mycobacterium haemophilum infection should be taken into consideration, especially when [acid fast bacilli] is seen by direct microscopy while routine mycobacterial cultures remain sterile." "A 75-year-old female with a history of type 2 [diabetes mellitus] and end stage renal disease received renal transplantation 18 years ago, was under mycophenolate mofetil and prednisolone as immunosuppression drug for years." Guo J-Y, et al. Multiple skin nodules in a post-renal-transplantation woman. International Journal of Antimicrobial Agents 50 (Suppl. 2): S101 abstr. PS 084, Nov 2017. Available from: URL: https://doi.org/10.1016/S0924-8579(17)30423-5 [abstract] - Taiwan 803323304 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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