NDT Advance Access originally published online on March 8, 2005
Nephrology Dialysis Transplantation 2005 20(8):1764-1765; doi:10.1093/ndt/gfh736
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Images in Nephrology
(Section Editor: G. H. Neild)
Cutaneous Mycobacterium abscessus infection after kidney transplantation
1 Nephrologie and 2 Pathologie, Charité Campus Benjamin Franklin, Berlin, Germany
Correspondence and offprint requests to: Dr Martin Tepel, Charité Campus Benjamin Franklin, Med. Klinik IV Nephrologie, Hindenburgdamm 30, D-12200 Berlin, Germany. Email: Martin.Tepel{at}charite.de
Keywords: kidney transplantation; Mycobacterium abscessus
Case
A 66-year-old man presented with a 1 month history of reddish-brown, circumscribed, infiltrative papules on the extremities (Figure 1A). The lesions developed central necroses and transformed into painful abscesses (Figure 1B; posterior thigh).
|
The patient had a history of anti-neutrophil cytoplasm antibodies-associated systemic vasculitis, presenting with severe renal disease. Combination therapy with cyclophosphamide and prednisolone had been terminated after 5 weeks due to treatment-related toxicity and development of end-stage renal disease. Subsequently, the patient had been on haemodialysis treatment for 18 months. Then, 3 months before presentation he had been transplanted with a cadaveric kidney. The immunosuppressive regimen consisted of prednisolone, cyclosporin A and mycophenolate mofetil.
The biopsy specimen obtained from the lesions showed acute panniculitis with abscess formation in the mid-dermis and few Langhans-type giant cells (Figure 1C). Numerous acid-fast bacilli could be demonstrated (Figure 1D). Culturing of a wound smear showed Mycobacterium abscessus. Drug sensitivity was tested. The patient received clarithromycin 250 mg twice daily and pyrazinamide 2 g daily. Treatment was continued for 8 months, during which the lesions showed regression and healing with scar formation.
Mycobacterium abscessus belongs to the family of rapid-growing atypical (non-tuberculous) mycobacteria. They can be isolated from water, soil and dust and have been identified in cutaneous and joint abscesses [1,2]. Infections caused by rapid-growing atypical mycobacteria have been described in immunocompromised patients and in patients with end-stage renal failure [1–3]. It is often misdiagnosed and treated as a fungal or common bacterial infection. Infections due to M. abscessus are currently managed by using the macrolide clarithromycin for several weeks, possibly in combination with amikacin or cefoxitin [1,4].
Conflict of interest statement. None declared.
References
- Brown-Elliott BA, Wallace RJ, Jr. Clinical and taxonomic status of pathogenic nonpigmented or late-pigmenting rapidly growing mycobacteria. Clin Microbiol Rev 2002; 15: 716–746
[Abstract/Free Full Text] - Bartralot R, Pujol RM, Garcia-Patos V et al. Cutaneous infections due to nontuberculous mycobacteria: histopathological review of 28 cases. Comparative study between lesions observed in immunosuppressed patients and normal hosts. J Cutan Pathol 2000; 27: 124–129[CrossRef][Medline]
- Lowry PW, Beck-Sague CM, Bland LA et al. Mycobacterium chelonae infection among patients receiving high-flux dialysis in a hemodialysis clinic in California. J Infect Dis 1990; 161: 85–90[Medline]
- Wallace RJ, Jr, Tanner D, Brennan PJ, Brown BA. Clinical trial of clarithromycin for cutaneous (disseminated) infection due to Mycobacterium chelonae. Ann Intern Med 1993; 119: 482–486
[Abstract/Free Full Text]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||