Disseminated Cutaneous Mycobacterium chelonae Infection in a Patient with Dermatomyositis

A 39-year-old Caucasian man with a history of dermatomyositis and diabetes mellitus on a regimen of tacrolimus and methylprednisolone presented to our dermatology outpatient clinic with a painful eruption on his left lower leg. Three months before presentation, he had been admitted to the hospital for cellulitis of the left leg. During admission, a needle aspirate of the left leg cellulitis was performed to obtain fluid for culture to guide therapy. The patient was empirically started on vancomycin 1 g every 12 hours and managed by infectious diseases. The culture yielded no growth, however, and the patient was continued on vancomycin for 2 weeks, with resolution of his cellulitis. Two months later, the patient developed multiple painful nodules on his left leg and returned to the infectious disease physician who had managed him during his inpatient stay. He was initially treated with 2 weeks of clindamycin 300 mg twice daily (bid) without improvement. This was then followed by 2 weeks of erythromycin 500 mg every 6 hours, again without improvement. At this point, he was referred to our clinic.