Small vessel vasculitis secondary to Mycobacterium chelonae
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Rheumatology International https://doi.org/10.1007/s00296-020-04697-z
INTERNATIONAL
CASE BASED REVIEW
Small vessel vasculitis secondary to Mycobacterium chelonae Monica Weinberg1 · Ayse Bag‑Ozbek1,2 · Davina Chen1 · Qingping Yao1 Received: 17 July 2020 / Accepted: 27 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Mycobacterial infection can be seriously debilitating and challenging to diagnose. The infection can mimic vasculitis associated with positive anti-neutrophilic cytoplasmic autoantibodies (ANCA). This clinical scenario is exemplified with a well-studied case of a 63-year-old Caucasian man with uncontrolled diabetes and ulcerative colitis on immunosuppressive agents. The patient was hospitalized for 3 months with worsening painful hand ulcerations. Primary vasculitis was first suspected, but the patient was later diagnosed with vasculitis secondary to Mycobacterium chelonae infection. Report includes discussion on sequence of testing which led to the diagnosis. After proper diagnosis and change to proper antibiotics, the patient’s vasculitis improved over time. It is our hope that this report further raises awareness of mycobacterial infection as a mimicker of vasculitis. We also provide a review of relevant literature on non-tuberculosis mycobacterial (NTM) infection including a review of 22 articles and 12 cases found in the literature. The salient features of the literature review include that 10 of the 12 cases were patients who had risk factors of immunosuppression due to medications, and all patients were infected by mycobacterium causing skin vasculitis. After given the proper directed antibiotic treatment, 11 of the 12 patients had a reported improved outcome. Keywords Mycobacterium chelonae · Vasculitis · ANCA · Ulcerative colitis
Introduction Non-tuberculous mycobacteria (NTM) are aerobic, nonmotile, acid-fast bacilli commonly found in soil and freshwater worldwide [1]. Over 170 species of NTM have been identified and are further categorized into rapidly growing mycobacteria (RGM) and slowly growing mycobacteria (SGM), based on cultures within 7 days. NTM infection can also present as nontender lymphadenitis, disseminated disease, * Ayse Bag‑Ozbek [email protected] Monica Weinberg [email protected] Davina Chen [email protected] Qingping Yao [email protected] 1
Division of Rheumatology, Allergy and Immunology, Department of Medicine, Stony Brook University Renaissance School of Medicine, Stony Brook University Hospital, HSC, T‑16, 047, Stony Brook, NY 11794‑8161, USA
Veterans Administration Medical Centers, Northport, NY, USA
2
skin and soft tissue infections, catheter-related infections, and chronic granulomatous infections of joints, tendons and bones [2, 3]. The incidence of cutaneous NTM infection has been increasing worldwide [4], and it may mimic systemic vasculitis. In the United States and Europe, the most common species are M. marinum, M. abscessus, M. fortunitum, and M. chelonae [5]. Of a
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