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A Case of Cutaneously Disseminated Mycobacterium haemophilum Infection Accompanying Blood Stream Infection
1)Laboratory for Clinical Investigation, Osaka University Hospital, 2)Division of Infection Control and Prevention, Osaka University Hospital
Keigo KIMURA1), Hideharu HAGIYA2), Tomomi MITSUI1), Isao NISHI1) & Kazunori TOMONO2)
(Received May 7, 2019)
(Accepted January 17, 2020)
Key words: Mycobacterium haemophilum, Mycobacterium leprae, 16SrDNA sequence

Mycobacterium haemophilum is a non-tuberculous mycobacterium that causes systemic infections involving the skin and soft tissue, pulmonary system, bones and joints, particularly in immunocompromised patients. We report herein on a rare case of cutaneously disseminated M. haemophilum infection accompanying blood stream infection in a patient following renal transplantation. A 41-year-old Japanese woman who had undergone a kidney transplant 5 years previously was referred to us due to prolonged undetermined fever. She was taking prednisolone, tacrolimus, everolimus, and mycophenolate mofetil at the time of hospitalization. In addition to the high fever, the patient suffered from chronic erythema emerging over her body. The results of Gram staining were suggestive of mycobacterium infection, and a genetic analysis based on sequencing of the hsp65 and rpoB genes finally identified this case to be a disseminated M. haemophilum infection. After we initiated combination therapy including clarithromycin, ciprofloxacin, and rifabutin, the patient's dermatological condition ameliorated and she was discharged 3 months later in remission.

Diagnosis of non-tuberculous mycobacterial infection is challenging from the aspect of both the clinical and laboratory approaches. In this case, careful observation of Gram staining in laboratory was a clue to the diagnosis of the infection. Among non-tuberculous mycobacteria, M. haemophilum is clinically a rare pathogen. Difficulty in identifying the pathogen may be a reason for its lower prevalence. M. haemophilum prefers a lower temperature (30-32°C) and requires iron or hemin (e.g. a blood agar plate) for proliferation, although we noticed that a chocolate agar plate in 5% CO2 at 35°C gave the best culture conditions in this case. In case of refractory and unidentified dermatologic diseases, attention should be paid to the possibility of mycobacterial infection.

[ Kansenshogaku Zasshi 94: 325-331, 2020 ]

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