IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 729 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
   [PDF Not available] *
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   Abstract
   Introduction
   Case Report
   Comments
   References

 Article Access Statistics
    Viewed3043    
    Printed56    
    Emailed0    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal

 


 
CASE REPORT
Year : 1993  |  Volume : 59  |  Issue : 1  |  Page : 33-34

Atypical mycobacterial infection in a case of systemic sclerosis




Correspondence Address:
Vilma Napier


Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions

  Abstract 

A case of systemic sclerosis on long term steroid therapy developed multiple abscesses in the skin and the knee joint. Atypical mycobacteria was isolated from the joint aspirate on two occasions. She responded only partially to treatment.


Keywords: Systemic sclerosis, Mycobacteria


How to cite this article:
Napier V, Sarojini P A, Ramani JB. Atypical mycobacterial infection in a case of systemic sclerosis. Indian J Dermatol Venereol Leprol 1993;59:33-4

How to cite this URL:
Napier V, Sarojini P A, Ramani JB. Atypical mycobacterial infection in a case of systemic sclerosis. Indian J Dermatol Venereol Leprol [serial online] 1993 [cited 2019 Nov 15];59:33-4. Available from: http://www.ijdvl.com/text.asp?1993/59/1/33/3876



  Introduction Top


Atypical mycobacteria are of low virulence and infection with them is rare. However, in some people with immunosuppression the disease can occur.


  Case Report Top


A 19- year-old girl, a known case of progressive systemic sclerosis (PSS) on prolonged steroid therapy, presented with a deep nonhealing ulcer extending into the muscle of the left thigh of 6 months duration. The lesion began as an abscess which was drained in a local hospital. Two weeks prior to admission she had developed pain and swelling of the left knee joint and she had bilateral swelling of the parotid glands. For these complaints she was treated with erythromycin, ibuprofen, and traction for 10 days and obtained relief.

After admission the ulcer showed little signs of healing. One month later she developed a respiratory infection. She was put on parenteral ampicillin and began to show mild improvement, subsequently a soft fluctuant swelling appeared on the arm above the left elbow. She also developed painful effusion of the left knee joint once again and high grade fever. The abscess on the arm was incised and 15 ml of pus was drained. This was sterile for pyogenic organisms. A blood count showed mild lymphocytosis. Blood cultures were sterile, the Widal test was negative. Sputum showed no acid fast bacilli (AFB). X-ray chest showed patchy consolidation of the right lower zone. An ELISA test for HIV was negative. The knee joint was aspirated and 10 ml pus obtained. The smear from the aspirate was positive for AFB both by Ziehl Neelsen staining and by the Auramine stains. She was then given isoniazid, rifampicin, and ethambutol. The joint aspirate sent for AFB culture showed growth at room temperature, 37 0 C, and 42 C in 14 days, without pigment production in the presence of light and in the dark. The colonies were yellowish - white, smooth, and easily emulsifiable. Subcultures in the dark and in the presence of light showed no pigment production. Blood cultures from the patient showed no growth. A culture from the second joint aspirate 1 week later showed the same mycobacteria in all respects.

It was concluded that the isolate was an atypical mycobacterium, probably a nonchromogen. The ulcers, however, did not heal and the knee joint effusion showed only sight improvement. Fever of 100-101 F persisted. Her general condition showed progressive worsening and she expired 7 months after admission.


  Comments Top


The diagnosis of atypical mycobacterial infections requires the satisfaction of certain criteria as put forward by the American Thoracic Society. A definitive diagnosis requires isolation from a closed lesion from which the specimen has to be collected and handled under sterile conditions.[ 1] In our case the joint aspirations were done under sterile conditions by an experienced orthopaedic surgeon. Isolation of the organism on 2 occasions within an interval of 1 week suggests that it was not a contaminant. Immunosuppression was present in this case as suggested by the presence of PSS, prolonged steroid therapy, and the poor general health.

The usual organisms associated with skin and soft tissue infections are rapid growers. [2] Joint and tendon infections are known to be produced by M. kansasi, M. avium intracellulare, and the rapid growers. [1],[3] In this case we could not classify the mycobacteria but it is probably a nonchromogen.

This case is being reported not only because of the rarity of the condition, but also to highlight the importance of suspecting atypical mycobacterial infection in the presence of cold abscesses in an immunosuppressed individual.

 
  References Top

1.Sanders WE Jr, Horowitz EA. Other mycobacterium species. In : Principles and practice of infectious diseases (Mandell GL, Douglas RG, Bennett JE, eds), 3rd edn. NewYork: Churchill Livingstone, 1990; 1914-23.  Back to cited text no. 1    
2.Inam PM, Beck, Brown AE, et al. Outbreak of injection abscesses. Arch Dermatol 1969; 100-41.  Back to cited text no. 2    
3.Sommers HM. Disease due to Mycobacteria other than Mycobacterium tuberculosis. In: Tuberculosis (Youmans GP, ed). Philadelphia : WB Saunders, 1979; 386-403.  Back to cited text no. 3    




 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow