A fatal Mycobacterium chelonae infection in an immunosuppressed patient with systemic lupus erythematosus and concomitant Fahr’s syndrome

We present a case of systemic Mycobacterium chelonae infection in an immunosuppressed patient with systemic lupus erythematosus (SLE), idiopathic hypoparathyroidism, and hypothyroidism. The patient was treated for 3 months for skin infection with clarithromycin monotherapy. Since her condition deter...

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Published in:Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy Vol. 17; no. 2; pp. 264 - 267
Main Authors: Zmak, Ljiljana, Obrovac, Mihaela, Katalinic Jankovic, Vera, Jankovic, Mateja, Krajinovic, Vladimir, Viskovic, Klaudija, Sestan Crnek, Sandra, Haris, Visnja
Format: Journal Article
Language:English
Published: Japan Elsevier Ltd 01.04.2011
Springer Japan
Subjects:
Anti-Bacterial Agents - therapeutic use
Basal Ganglia Diseases - complications
Case Report
Croatia
Fahr's syndrome
Fatal Outcome
Female
Hematology, Oncology and Palliative Medicine
Humans
Immunocompromised Host
Infectious Diseases
Lupus Erythematosus, Systemic - complications
Medical Microbiology
Medicine
Medicine & Public Health
Middle Aged
Mycobacterium chelonae
Mycobacterium chelonae - isolation & purification
Mycobacterium Infections, Nontuberculous - complications
Mycobacterium Infections, Nontuberculous - drug therapy
Mycobacterium Infections, Nontuberculous - microbiology
Nontuberculous mycobacteria
Skin Diseases, Bacterial - complications
Skin Diseases, Bacterial - drug therapy
Skin Diseases, Bacterial - microbiology
Syndrome
Systemic lupus erythematosus
Virology
Croatia
Mycobacterium chelonae
Systemic lupus erythematosus
Fahr’s syndrome
Nontuberculous mycobacteria
ISSN:1341-321X, 1437-7780, 1437-7780
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Summary:We present a case of systemic Mycobacterium chelonae infection in an immunosuppressed patient with systemic lupus erythematosus (SLE), idiopathic hypoparathyroidism, and hypothyroidism. The patient was treated for 3 months for skin infection with clarithromycin monotherapy. Since her condition deteriorated, the antibiotic therapy was switched to intravenously administered clindamycin, cloxacillin, and meropenem. Due to further deterioration and isolation of M. chelonae from the blood culture, antimicrobial therapy was changed to azithromycin and amikacin. Drug-test sensitivity was performed, and the isolate was susceptible to clarithromycin only. The patient’s deteriorating status prevented orally administered medication with clarithromycin (parenteral formulation is not registered in Croatia). The same antibiotic regime was continued until the isolation of Pseudomonas aeruginosa and Candida albicans. In addition, extensive calcifications in her brain were found on a computed tomography (CT) scan, which suggested Fahr’s syndrome. Despite all measures and supportive care, the patient developed multiorgan failure and eventually died. There has been an increase in the number of infections by rapidly growing mycobacteria, but only a few cases of severe systemic infection with M. chelonae have been described. If the infection is diagnosed early and a patient is treated with appropriate drugs, dissemination can be avoided despite immunosuppression. For serious skin, bone, and soft-tissue disease, a minimum of 4 months of a combined drug therapy is necessary. This is the first report of M. chelonae infection in Croatia and the first-described M. chelonae infection in a patient with concomitant Fahr’s syndrome.
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ISSN:1341-321X
1437-7780
1437-7780
DOI:10.1007/s10156-010-0110-4