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Case report
Case of atypical cutaneous Mycobacteriumchelonae infection in patient of systemic lupus erythematosus after cyclophosphamide therapy
  1. Sheraz Rasool1,
  2. Amr Afifi1 and
  3. Denise De Lord2
  1. 1Medicine, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, UK
  2. 2Rheumatology, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
  1. Correspondence to Dr Sheraz Rasool; sheraz.rasool{at}nhs.net

Abstract

Mycobacteriumchelonae is one of the rapidly growing non-tuberculous mycobacteria that can be isolated from water, soils and aerosols. Localised infections have been reported associated with tattoo parlours, pedicures and cosmetic procedures. But disseminated infection is usually associated with individuals who are immunocompromised, predominantly affecting limbs but sparing abdomen and back. We herein present a case where patient was on immunosuppressive therapy and developed locally severe infection around right ankle. A 69-year-old woman known to rheumatology presents in outpatients with severe pain in right ankle, unable to bear weight, oedematous right foot and lower leg. There was extensive erythematous cellulitic skin rash around right ankle and lower leg. She had background history of systemic lupus erythematosus with previous history of cardiac myositis and left foot drop. She had six cycles of cyclophosphamide for flare of lupus and after last cycle developed this presentation. Skin biopsy was arranged with dermatologist, cultures from which grew M.chelonae. She was admitted and started on triple regimen for M.chelonae as per Microbiology guidelines with intention to complete 6–12 months treatment. Patient responded very well to treatment but unfortunately, she died after 5 months on treatment due to other comorbidities and likely cause of death was cardiac arrhythmia.

  • systemic lupus erythematosus
  • infectious diseases
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Footnotes

  • Contributors SR has written up case report, looked after patient and reviewed literature. AA has been involved in looking after our patient and searching literature reviews for this atypical infection. Consultant DDL has reviewed the case report and helped in writing up this report at every single step.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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