Images of Infectious Diseases
65F with an “autoimmune illness”
Prednisone / MTX. Now rituximab.
Progressive skin lesions for 9 months. No systemic symptoms.
Skin biopsy Gram stain (photo)
Your differential diagnosis?
65F with an “autoimmune illness”
Prednisone / MTX. Now rituximab.
Progressive skin lesions for 9 months. No systemic symptoms.
Skin biopsy Gram stain (photo)
Your differential diagnosis?
Excellent #IDTwitter differentials: coryne, nocardia, actino, NTM.
Fite stain loaded with AFB. Mycobacterial culture + at day 7 of subculture.
#IDBR #MayoIDQ the organism was reported as NOT having inducible erythromycin methylase gene.
Name the pathogen.
Fite stain loaded with AFB. Mycobacterial culture + at day 7 of subculture.
#IDBR #MayoIDQ the organism was reported as NOT having inducible erythromycin methylase gene.
Name the pathogen.
3/
Case diagnosis: #Mycobacterium #chelonae skin and soft tissue infection
Rx:
Reduce immunosuppression
Azithromycin + tobramycin (+ moxifloxacin initially)
Case diagnosis: #Mycobacterium #chelonae skin and soft tissue infection
Rx:
Reduce immunosuppression
Azithromycin + tobramycin (+ moxifloxacin initially)
4/
#erm gene in #RGM
Inducible erm gene —> R to macrolides
1. M #abscessus (subsp: abscessus, #bolletti)
2. M #fortuitum
Phenotypic: incubate w #clarithromycin for 14d
#Erm NOT present (often macrolide-S)
1. M #chelonae
2. M abscessus #massiliense
ncbi.nlm.nih.gov
#erm gene in #RGM
Inducible erm gene —> R to macrolides
1. M #abscessus (subsp: abscessus, #bolletti)
2. M #fortuitum
Phenotypic: incubate w #clarithromycin for 14d
#Erm NOT present (often macrolide-S)
1. M #chelonae
2. M abscessus #massiliense
ncbi.nlm.nih.gov
/5
#Mycobacterium #chelonae #Pearls
1. #RGM #NTM
2. Variable clinical syndrome
3. Risk: ICH; surgical/cosmetic; prosthesis
4. NO erm gene (macrolide S)
5. Complex Rx: 2-3 agent combo; often macrolide and Tobramycin-S); surgery if needed
Thanks for participating!
#Mycobacterium #chelonae #Pearls
1. #RGM #NTM
2. Variable clinical syndrome
3. Risk: ICH; surgical/cosmetic; prosthesis
4. NO erm gene (macrolide S)
5. Complex Rx: 2-3 agent combo; often macrolide and Tobramycin-S); surgery if needed
Thanks for participating!
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