Mycobacterium haemophilum Infection in a Patient With Systemic Lupus Erythematosus and Antisynthetase Syndrome: A Case Report and Literature Review

Nontuberculous mycobacteria infections exhibit a broad and heterogeneous clinical spectrum, predominantly affecting immunocompromised individuals, particularly those with CD4⁺ T-lymphocyte depletion. We report the case of a 61-year-old woman with systemic lupus erythematosus and antisynthetase syndrome, receiving treatment with mycophenolate mofetil (MMF) and prednisolone, who presented with small erythematous, papular, and exudative skin lesions involving both legs and feet. Direct staining revealed atypical acid-fast bacilli, and polymerase chain reaction identified Mycobacterium haemophilum. Within a few weeks, new lesions developed, progressing to extensive ulceration. Empirical triple therapy with azithromycin, moxifloxacin, and rifabutin was initiated, while MMF was discontinued and prednisolone tapered to 5 mg daily. Intravenous immunoglobulin (IVIG) was introduced to control immune disease activity. Gradual clinical improvement was achieved over the following months. This case highlights the challenges of managing M. haemophilum infection while balancing infection control and immunomodulation, and supports IVIG as a safe adjunctive therapeutic option.