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.
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The case was followed and diagnosed by the authors who participated in the patient care. ABO, MW, DC, and QY participated in the analysis of the case as well as interpretation of the data. The manuscript with literature review was written and prepared by ABO, MW, and DC, and QY reviewed and edited the manuscript. ABO and QY have overseen the accuracy and integrity of the manuscript.
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Weinberg, M., Bag-Ozbek, A., Chen, D. et al. Small vessel vasculitis secondary to Mycobacterium chelonae. Rheumatol Int 41, 1691–1697 (2021). https://doi.org/10.1007/s00296-020-04697-z
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DOI: https://doi.org/10.1007/s00296-020-04697-z