Atypical Mycobacterial Infection Arising Amid Corticosteroid Therapy for Livedoid Vasculopathy

Area of Science:

• Dermatology
• Infectious Diseases
• Microbiology

Background:

• Livedoid vasculopathy (LV) is a rare condition lacking definitive treatment, often managed with corticosteroids.
• Corticosteroids, while alleviating LV pain, carry risks like immunosuppression.
• Diabetes mellitus is a common comorbidity in patients with chronic inflammatory conditions.

Observation:

• A case of disseminated cutaneous infection caused by Mycobacterium chelonae/abscessus is presented.
• The infection occurred in a diabetic patient with a history of long-term corticosteroid use.
• The patient presented with a diffuse onset of ulcerative skin nodules.

Findings:

• The patient required an intensive antibiotic regimen for the disseminated cutaneous infection.
• Potential lifelong antibiotic suppression may be necessary pending infection improvement.
• Rapidly growing mycobacterial (RGM) infections should be considered in immunocompromised patients with specific skin manifestations.

Implications:

• This case highlights the importance of considering atypical mycobacterial infections in patients with risk factors like diabetes and corticosteroid use.
• Increased awareness can lead to earlier diagnosis and appropriate management of these rare but serious infections.
• Further research into the interplay between immunosuppression, diabetes, and mycobacterial skin infections is warranted.