Prednisolone
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Disseminated panniculitis caused by Mycobacterium chelonae: case report. An 82-year-old woman developed disseminated panniculitis caused by Mycobacterium chelonae while being treated with prednisolone. The woman was referred for treatment of disseminated skin lesions in September 2018. She had a history of eosinophilic granulomatosis with polyangiitis. Since the diagnosis of the eosinophilic granulomatosis with polyangiitis 1 year earlier, she was initiated on treatment with prednisolone 40mg daily [route not stated]. One month before, her lesions appeared as inflammation to subcutaneous nodules on the long axis of about 1cm, affecting the four limbs. Few of the inflammations to the subcutaneous nodules were leaking in small amounts of pus and fistulous. She had a fever of 39 degree Celsius and elevated serum C-reactive protein 96 mg/mL. The transthoracic ultrasound ruled out diagnosis of infective endocarditis. Her blood cultures were sterile. Biopsy of the deep skin layers was performed. After suitable staining, histological test revealed lobular and septal, granulomatous and suppurative panniculitis, with the presence of mycobacteria. Direct bacteriological test showed acid-fast bacilli and the culture of the specimen was Mycobacterium chelonae positive. The woman was treated with clarithromycin, minocycline and linezolid. A transient regression of the lesions was observed during the antibiotic therapy. However, 1 year after the antibiotic therapy, her symptoms worsened due to poor compliance. New antibiotic combination of clarithromycin, tedizolid and tigecycline was initiated with further improvements in her symptoms. Author comment: "Immunosuppression, and particularly prolonged corticosteroid therapy, is the main risk factor for M. chelonae infection." Rossi F, et al. Panniculite disseminee a Mycobacterium chelonae. Revue de Medecine Interne 40 (Suppl. 2): A203, Dec 2019. Available from: URL: http:// doi.org/10.1016/j.revmed.2019.10.309 [French abstract; summarised from a 803440105 translation] - France
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Reactions 21 Dec 2019 No. 1784
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