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Nielsen M, Kreiter C, Polsfuß S, Krause A. [Two severe cases of disseminated cutaneous nontuberculous mycobacteriosis due to Mycobacterium haemophilum]. Z Rheumatol 2023; 82:143-150. [PMID: 34825949 DOI: 10.1007/s00393-021-01131-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/26/2022]
Abstract
Mycobacterium haemophilum is a rare pathogen belonging to the group of slowly growing nontuberculous mycobacteria (NTM) that can cause infections, especially in immunocompromised patients. Detection by culturing is difficult because M. haemophilum only grows under special cultivation conditions. Therefore, it is believed that the pathogen is too rarely identified as a cause of disease overall. In addition to patients with severe immunodeficiency, e.g. due to acquired immunodeficiency syndrome (AIDS), chemotherapy or immunosuppression after transplantation, patients with underlying rheumatic diseases are increasingly described in the literature, who are at risk due to the immunosuppressive treatment regimen. Clinically, ulcerative skin alterations, lymphadenopathy and arthropathy are in the foreground. In immunosuppressed patients with unclear skin lesions, infections due to M. haemophilum should be considered and specific microbiological diagnostics should be initiated.
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Affiliation(s)
- Martin Nielsen
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie - Standort Wannsee, Immanuel Krankenhaus Berlin - Klinik für Innere Medizin, Berlin, Deutschland.
| | - Carolin Kreiter
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie - Standort Buch, Immanuel Krankenhaus Berlin - Klinik für Innere Medizin, Berlin, Deutschland
| | - Silke Polsfuß
- Immunologie und Laboratoriumsmedizin, Helios Klinikum Emil von Behring Berlin - Institut für Mikrobiologie, Berlin, Deutschland
| | - Andreas Krause
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie - Standort Wannsee, Immanuel Krankenhaus Berlin - Klinik für Innere Medizin, Berlin, Deutschland
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie - Standort Buch, Immanuel Krankenhaus Berlin - Klinik für Innere Medizin, Berlin, Deutschland
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2
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Kuo YN, Lai CS, Chen YH, Kuo-Lung L. Severe thoracic pyomyositis in a patient with systemic lupus erythematosus. BMJ Case Rep 2022; 15:15/3/e246484. [PMID: 35260400 PMCID: PMC8905888 DOI: 10.1136/bcr-2021-246484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pyomyositis may mimic deep vein thrombosis and be misdiagnosed in patients with systemic lupus erythematosus (SLE). We report here on patient with SLE with severe thoracic pyomyositis presented with right upper arm swelling and fever. The patient fully recovered after a serial surgical debridement and antibiotic therapy. Pyomyositis, as well as deep vein thrombosis, should be considered during the differential diagnosis of patients with SLE experiencing fever and unilateral limb oedema. CT and identification of causal pathogens are crucial in the diagnosis of pyomyositis. Early effective antibiotic treatment as well as surgical intervention can together bring about a better outcome.
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Affiliation(s)
- Yu-Ning Kuo
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chih-Sheng Lai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Lai Kuo-Lung
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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3
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Su T, Jameel AAB, Wang H, Su Z, Lu Y. Disseminated Cutaneous Infection by Mycobacterium haemophilum in a Woman With Systemic Lupus Erythematosus. J Clin Rheumatol 2021; 27:e198-e199. [PMID: 32251044 DOI: 10.1097/rhu.0000000000001365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ting Su
- From the Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University
| | - Afzaal Ahmed Bin Jameel
- From the Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University
| | - Hongsheng Wang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Zhonglan Su
- From the Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University
| | - Yan Lu
- From the Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University
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Giannotta JA, Fattizzo B, Cavallaro F, Barcellini W. Infectious Complications in Autoimmune Hemolytic Anemia. J Clin Med 2021; 10:E164. [PMID: 33466516 PMCID: PMC7796467 DOI: 10.3390/jcm10010164] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 12/16/2022] Open
Abstract
Autoimmune hemolytic anemia (AIHA) may be frequently challenged by infectious complications, mainly as a result of immunosuppressive treatments administered. Furthermore, infectious agents are known triggers of AIHA onset and relapse. Although being risk factors for mortality, infections are an underestimated issue in AIHA. This review will collect the available evidence on the frequency and type of infectious complications in AIHA, detailing the risk related to each treatment (i.e., steroids, rituximab, splenectomy, classic immunosuppressive agents, and new target drugs). Moreover, we will briefly discuss the infectious complications in AIHA secondary to other diseases that harbor an intrinsic infectious risk (e.g., primary immunodeficiencies, systemic autoimmune diseases, lymphoproliferative disorders, solid organ and hematopoietic stem cell transplants). Finally, viral and bacterial reactivations during immune suppressive therapies will be discussed, along with suggested screening and prophylactic strategies.
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Affiliation(s)
- Juri Alessandro Giannotta
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20100 Milan, Italy; (B.F.); (F.C.); (W.B.)
| | - Bruno Fattizzo
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20100 Milan, Italy; (B.F.); (F.C.); (W.B.)
- Department of Oncology and Oncohematology, University of Milan, Via Festa del Perdono 7, 20100 Milan, Italy
| | - Francesca Cavallaro
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20100 Milan, Italy; (B.F.); (F.C.); (W.B.)
- Department of Oncology and Oncohematology, University of Milan, Via Festa del Perdono 7, 20100 Milan, Italy
| | - Wilma Barcellini
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20100 Milan, Italy; (B.F.); (F.C.); (W.B.)
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5
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Malpica L, Moll S. Practical approach to monitoring and prevention of infectious complications associated with systemic corticosteroids, antimetabolites, cyclosporine, and cyclophosphamide in nonmalignant hematologic diseases. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2020; 2020:319-327. [PMID: 33275674 PMCID: PMC7727566 DOI: 10.1182/hematology.2020000116] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Corticosteroids constitute a first-line therapy for adults and children suffering from nonmalignant immune-mediated hematologic diseases. However, high disease relapse rates during the tapering period or upon drug discontinuation result in long-term corticosteroid use that increases the risk of infection. This same concept applies to other immunosuppressive agents, such as antimetabolites, calcineurin inhibitors, and cyclophosphamide. Corticosteroids are associated with a length-of-treatment and dose-dependent risk for infection. Screening and antimicrobial prophylaxis against tuberculosis, hepatitis B, Strongyloides stercoralis, and Pneumocystis jirovecii pneumonia (PJP) might be indicated in patients who are scheduled to be on high-dose corticosteroids for >4 weeks (>30 mg of prednisone-equivalent dose [PEQ]) or in patients chronically treated (≥8 weeks of continuous or intermittent corticosteroid use) with moderate doses (≥15 to <30 mg PEQ). Antimetabolites (azathioprine, mycophenolate) increase the risk of progressive multifocal leukoencephalopathy (PML); however, other opportunistic infections and viral reactivation have also been reported. In case of new onset of neurological symptoms, PML needs to be considered, and an urgent neurology consultation should be obtained. Cyclophosphamide-induced myelosuppression can lead to serious infections related to neutropenia. PJP prophylaxis should be considered with combination therapy of cyclophosphamide and corticosteroids until a PEQ dose ≤ 5 mg/d is reached. Data on infectious risk when cyclosporine is used in patients with nonmalignant hematologic diseases are lacking. Discontinuation of any immunosuppressive agent during an episode of infection is recommended. In all patients, adherence to an age-based immunization schedule is appropriate.
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Affiliation(s)
- Luis Malpica
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Stephan Moll
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
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6
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Malpica L, van Duin D, Moll S. Preventing infectious complications when treating non-malignant immune-mediated hematologic disorders. Am J Hematol 2019; 94:1396-1412. [PMID: 31571266 DOI: 10.1002/ajh.25642] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 01/19/2023]
Abstract
Immunosuppressants, targeted antibody therapies, and surgical splenectomy are amongst the treatment choices for immune-mediated non-malignant hematologic disorders, with infection being the most common non-hematological adverse event from these therapies. Corticosteroids are associated with a length-of-treatment and dose-dependent risk for infection, including opportunistic infections. Screening and antimicrobial prophylaxis against tuberculosis, Strongyloides stercoralis, and Pneumocystis jirovecii pneumonia, are indicated in selected patients on steroids and with certain risk factors for infection. Rituximab is associated with hepatitis B virus reactivation. All patients planned to be started on rituximab should be screened for hepatitis B surface antigen and total core antibody, with antiviral prophylaxis given depending on test results. In eculizumab treated patients, immunization against meningococcal serogroups ACWY and B is recommended. In addition, some guidelines suggest antibiotic prophylaxis for the duration of eculizumab treatment. In splenectomized patients, counseling and immunization are cornerstones of infection prevention. Several federal and society guidelines about immunizations and prophylactic antimicrobial therapies for patients treated with various immunosuppressive agents exist and are summarized in this manuscript in a clinical-focused table. In addition, management suggestions are made where no formal guidelines exist.
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Affiliation(s)
- Luis Malpica
- Department of Medicine, Division of Hematology and Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - David van Duin
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Stephan Moll
- Department of Medicine, Division of Hematology and Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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7
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Shaharir SS, Sulaiman Sahari N, Mohamed Fuad Z, Zukiman WZHW, Mohd Yusof NH, Sulong A, Periasamy P. Non-tuberculous mycobacterium bacteraemia in a pregnant systemic lupus erythematosus (SLE) patient: a case review and pooled case analysis. Clin Rheumatol 2017; 37:837-847. [DOI: 10.1007/s10067-017-3855-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/20/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
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8
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Meesiri S. Pyomyositis in a patient with systemic lupus erythaematosus and a review of the literature. BMJ Case Rep 2016; 2016:10.1136/bcr-2016-214809. [PMID: 27090546 DOI: 10.1136/bcr-2016-214809] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pyomyositis (PM) is a common masquerading disease that is frequently misdiagnosed. A concurrent state of immunodeficiency is observed in up to 75% of tropical PM cases. PM in systemic lupus erythaematosus (SLE) is a relatively rare disease. I report a case of PM that was caused byKlebsiella pneumoniaein a patient with SLE who presented with leg pain, fever and a lupus flare-up. The patient was correctly diagnosed using a CT scan. Immediate surgical drainage was performed, and empirical antibiotics were administered. The patient was discharged while in a recovering condition. The clinical features, the results of radiographic investigations and the management of PM in SLE are synopsised in this article to underscore the importance of considering this relatively rare disease during differential diagnosis in patients with SLE with muscle pain with or without fever. I also emphasise the need to exclude mycobacterial infection in patients with SLE with PM.
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Affiliation(s)
- Somchai Meesiri
- Department of Surgery, Mae Sot General Hospital, Mae Sot, Tak, Thailand
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9
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Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multisystem organ involvement, heterogeneity of clinical features, and variety in degree of severity. The differential diagnosis is a crucial aspect in SLE as many other autoimmune diseases portray clinical similarities and autoantibody positivity. Lupus mimickers refer to a group of conditions that exhibit both clinical features and laboratory characteristics, including autoantibody profiles that resemble those present in patients with SLE, and prompt a diagnostic challenge in everyday clinical practice. Thus, lupus mimickers may present as a lupus-like condition (i.e., 2 or 3 criteria) or as one meeting the classification criteria for SLE. Herein we review and classify the current literature on lupus mimickers based on diverse etiologies which include infections, malign and benign neoplasms, medications, and vaccine-related reactions.
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Affiliation(s)
- Omar-Javier Calixto
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; Mederi, Hospital Universitario Mayor, Bogotá, Colombia
| | - Juan-Sebastian Franco
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; Mederi, Hospital Universitario Mayor, Bogotá, Colombia
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia; Mederi, Hospital Universitario Mayor, Bogotá, Colombia.
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10
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Mycobacterium haemophilum as the Initial Presentation of a B-Cell Lymphoma in a Liver Transplant Patient. Case Rep Rheumatol 2014; 2014:742978. [PMID: 24523979 PMCID: PMC3913284 DOI: 10.1155/2014/742978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/26/2013] [Indexed: 11/17/2022] Open
Abstract
A 66-year-old woman presented with pustular lesions of her face, trunk, and limbs and an acute arthritis of the knees and elbows.
She had a complex medical background and had been on immunosuppressants for three years after a liver transplant. Tissue samples from her skin lesions and synovial fluid showed acid-fast bacilli. Mycobacterium haemophilum, an atypical mycobacteria, was later grown on culture. During her treatment with combination antibiotic therapy, she developed a pronounced generalised lymphadenopathy. Histology showed features of a diffuse B-cell lymphoma, a posttransplant lymphoproliferative disorder (PTLD).
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11
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Skin Nontuberculous Mycobacterial Infection in Systemic Lupus Erythematosus: An Unusual Skin Infection Mimicking Lupus Vasculitis. Semin Arthritis Rheum 2013; 42:498-506. [DOI: 10.1016/j.semarthrit.2012.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 07/30/2012] [Accepted: 08/09/2012] [Indexed: 11/17/2022]
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12
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Clinical manifestations, diagnosis, and treatment of Mycobacterium haemophilum infections. Clin Microbiol Rev 2012; 24:701-17. [PMID: 21976605 DOI: 10.1128/cmr.00020-11] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mycobacterium haemophilum is a slowly growing acid-fast bacillus (AFB) belonging to the group of nontuberculous mycobacteria (NTM) frequently found in environmental habitats, which can colonize and occasionally infect humans and animals. Several findings suggest that water reservoirs are a likely source of M. haemophilum infections. M. haemophilum causes mainly ulcerating skin infections and arthritis in persons who are severely immunocompromised. Disseminated and pulmonary infections occasionally occur. The second at-risk group is otherwise healthy children, who typically develop cervical and perihilar lymphadenitis. A full diagnostic regimen for the optimal detection of M. haemophilum includes acid-fast staining, culturing at two temperatures with iron-supplemented media, and molecular detection. The most preferable molecular assay is a real-time PCR targeting an M. haemophilum-specific internal transcribed spacer (ITS), but another approach is the application of a generic PCR for a mycobacterium-specific fragment with subsequent sequencing to identify M. haemophilum. No standard treatment guidelines are available, but published literature agrees that immunocompromised patients should be treated with multiple antibiotics, tailored to the disease presentation and underlying degree of immune suppression. The outcome of M. haemophilum cervicofacial lymphadenitis in immunocompetent patients favors surgical intervention rather than antibiotic treatment.
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13
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Kelley CF, Armstrong WS, Eaton ME. Disseminated Mycobacterium haemophilum infection. THE LANCET. INFECTIOUS DISEASES 2011; 11:571-8. [DOI: 10.1016/s1473-3099(11)70029-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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14
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Lott JP, Werth VP, Kovarik CL. Cutaneous Mycobacterium haemophilum infection in iatrogenically immunocompromised patients without transplantation. J Am Acad Dermatol 2008; 59:139-42. [PMID: 18328595 DOI: 10.1016/j.jaad.2008.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 01/01/2008] [Accepted: 01/27/2008] [Indexed: 10/22/2022]
Abstract
Cutaneous Mycobacterium haemophilum infections are most often the result of HIV or transplantation-associated immunosuppression. Rarely, M. haemophilum may infect healthy patients or iatrogenically immunosuppressed patients without transplantation. We herein report two cases of cutaneous M. haemophilum infection in HIV-negative patients without transplantation undergoing iatrogenic immunosuppression. Our cases and a literature review highlight the various clinical contexts in which M. haemophilum may arise in this patient population. Accordingly, we emphasize that a high index of suspicion is needed for diagnosis, which ultimately relies on skin biopsy, histopathologic examination, and culture.
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Affiliation(s)
- Jason P Lott
- Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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15
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Abstract
Mycobacterium haemophilum is an emerging cutaneous and systemic pathogen in immunosuppressed adults. Reports in the pediatric literature prior to 2004, limited to immunocompetent children with lymphadenitis, offer a different clinical presentation from that of the immunosuppressed adult. We report an instance of this atypical mycobacterial infection occurring in an immunosuppressed boy with clinical findings similar to those described in immunosuppressed adults.
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Affiliation(s)
- Lisa B Campbell
- Department of Dermatology, Geisinger Medical Centre, Danville, Pennsylvania 17822, USA
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16
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Mercadal L, Foltz V, Isnard-Bagnis C, Ourahma S, Deray G. Tuberculosis After Conversion From Azathioprine to Mycophenolate Mofetil in a Long-Term Renal Transplant Recipient. Transplant Proc 2005; 37:4241-3. [PMID: 16387088 DOI: 10.1016/j.transproceed.2005.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Indexed: 01/31/2023]
Abstract
We report the third case in the literature of a patient with a long-lasting renal allograft who experienced tuberculosis just after the switch from azathioprine to mycophenolate mofetil. The switch was likely responsible for the reactivation of dormant tuberculosis; prophylactic antituberculous treatment should be considered in cases of such a therapeutic change.
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Affiliation(s)
- L Mercadal
- Department of Nephrology, Pitié-Salpétrière Hospital, Paris, France.
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Bosma F, Deckers-Kocken JM, de Graaf SSN, Schülin T, Melchers WJG, Hoogkamp-Korstanje JA. Mycobacterium reverse hybridization line-probe assay used to diagnose disseminated Mycobacterium haemophilum infection in a child with acute lymphoblastic leukemia. Eur J Clin Microbiol Infect Dis 2004; 23:345-7. [PMID: 15007704 DOI: 10.1007/s10096-004-1102-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- F Bosma
- Department of Medical Microbiology, University Medical Centre Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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