Mycobacterium marinum infection in an immunocompromised patient with infliximab
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MOLINELLI Claudia SAPIGNI Giovanni Marco D’AGOSTINO Valerio BRISIGOTTI Anna CAMPANATI Annamaria OFFIDANI
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Mycobacterium marinum infection in an immunocompromised patient with infliximab Mycobacterium (M.) marinum is a waterborne nontuberculosis mycobacterium that can cause granulomatous infections of the skin, typically following minor trauma [1]. We present herein a severely prolonged infection by M. marinum in an immunocompromised patient treated with infliximab. A 48-year-old man presented to our dermatology department with a one-month history of a lesion of the nailfold of the right ring finger and multiple painless skin lesions on his right upper extremity. The patient had cleaned his two aquariums without gloves and had suffered a small wound on his right ring finger. He had ulcerative colitis treated with infliximab for 1.5 years. Physical examination revealed an inflamed crusted lesion of the nailfold of the right ring finger and multiple disseminated cutaneous and subcutaneous nodules of up to two centimetres in size distributed in a sporotrichoid pattern on the back of his right hand, forearm and upper arm (figure 1A). No internal organs were involved. M. marinum was identified in solid cultures from a skin biopsy. The infusions of infliximab were discontinued and the patient was treated orally with clarithromycin, 500 mg twice daily, ethambutol 2 g and rifampicin 600 mg once daily. After one month of therapy, the patient developed a swelling of the dorsal lower arm. Magnetic
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