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Disseminated Mycobacterium haemophilum Infection in a Patient Receiving Infliximab for Rheumatoid Arthritis
1)Department of Medicine and Biosystemic Science, Faculty of Medicine, Kyushu University, 2)Clinical Education Center, Kyushu University Hospital, 3)Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital, 4)Center for the Study of Global Infection, Kyushu University Hospital
Aya OKABE1), Noriko MIYAKE1)2), Akiko YONEKAWA1), Yuiko MOROKUMA3), Ruriko NISHIDA1)3), Yoji NAGASAKI1), Yong CHONG1), Shinji SHIMODA1)2) & Nobuyuki SHIMONO1)4)
(Received January 22, 2018)
(Accepted August 9, 2018)
Key words: Mycobacterium haemophilum, infliximab, Rheumatoid arthritis

Mycobacterium haemophilum has been described as a pathogen that causes cutaneous infections, septic arthritis, and pneumonitis in immunocompromised patients. It is being increasingly recognized in patients who have received treatment with anti-tumor necrosis factor-α (TNFα) agents, such as infliximab (IFX). We present a case of a 69-year-old female with a history of rheumatoid arthritis, who following treatment with prednisolone, methotrexate, and IFX for 7 years, developed disseminated M. haemophilum disease, which included cervical lymphadenitis, a lower leg subcutaneous tumor, and an upper eyelid conjunctive mass. Histological examination of biopsy specimens from the eyelid conjunctive mass, lymph node, and lower leg subcutaneous mass revealed granuloma with epithelioid cells and the presence of acid-fast bacilli (AFB) in the lymph node tissue. Molecular genetic analyses using the polymerase chain reaction method excluded Mycobacterium tuberculosis and Mycobacterium avium complex. Biopsy specimens cultured using BACTEC FX bottle (Becton Dickinson) and 2% Ogawa medium at 30°C showed negative results. Subsequent testing of the frozen tissue specimens from the cervical LN and lower leg subcutaneous mass using mycobacterial DNA, hsp65, rpoB, 16S rRNA gene sequence analysis identified M. haemophilum. The patient was successfully treated with rifampicin, clarithromycin, and sitafloxacin. M. haemophilum infection should be considered in ulcerating skin lesions and/or arthritis, and pneumonia in patients treated with anti-TNFα agents, especially when microscopic observation reveals the presence of AFB and a routine mycobacterial culture remains negative.

[ Kansenshogaku Zasshi 92: 878-883, 2018 ]

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