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Two Episodes of Cutaneous Non-Tuberculous Mycobacterial Infection in a Patient with Psoriasis

Wai Sze Agnes Chan1, Shang-Ian Tee1, Nisha Su Yien Chandran2

  • 1Department of Dermatology, National Skin Centre , Singapore.

Dermatology Reports
|August 4, 2015
PubMed

Insights

This case study details two separate non-tuberculous mycobacteria (NTM) skin infections in one patient, highlighting the need for diagnostic vigilance in NTM disease.

Area of Science:

  • Microbiology
  • Immunology
  • Dermatology

Background:

  • Non-tuberculous mycobacteria (NTM) are increasingly recognized as significant pathogens causing diverse diseases, particularly in immunocompromised individuals.
  • Recent decades show a rise in NTM infections, even in immunocompetent populations.
  • Cutaneous NTM infections present a diagnostic challenge, necessitating awareness of various species and risk factors.

Observation:

  • A 79-year-old Chinese woman on methotrexate for psoriasis developed a cutaneous infection caused by Mycobacterium abscessus.
  • Lesions resolved with a combination antibiotic regimen.
  • Five years after methotrexate cessation, she experienced a second, distinct cutaneous NTM infection with Mycobacterium haemophilum in the same area.

Findings:

  • The patient experienced two independent cutaneous NTM infections with different species (M. abscessus and M. haemophilum) years apart.
  • Methotrexate therapy may be a risk factor for NTM skin infections.
  • Recurrence with a different NTM species underscores the complexity of NTM pathogenesis.

Implications:

  • This case emphasizes the importance of considering NTM in the differential diagnosis of persistent skin lesions, especially in patients with risk factors.
  • Vigilance for NTM infections is crucial, even after initial treatment and cessation of immunosuppressive therapy.
  • Understanding risk factors and diagnostic approaches for cutaneous NTM is vital for effective patient management.
Keywords:
Mycobacterium abscessusMycobacterium hemophilumcutaneousnon tuberculous mycobacteriapsoriasis

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