Skip to main content

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

Abstract

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. Brown-Elliot BA, Wallace RJ Jr. Infections caused by nontuberculous mycobacteria. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas and Bennett’s principles and practice of infectious diseases. 6th ed, vol 2. Philadelphia: Elsevier-Churchill Livingston; 2004. p. 2909–16.

  2. Wallace RJ Jr, Brown BA, Onyi GO. Skin, soft tissue and bone infections due to Mycobacterium chelonae: importance of prior corticosteroid therapy, frequency of disseminated infections and resistance to oral antimicrobials other than clarithromycin. J Infect Dis. 1992;166:405–12.

    PubMed  Article  Google Scholar 

  3. Meyers H, Brown-Elliott BA, Moore D, Curry J, Truong C, Yansheng Z, et al. An outbreak of Mycobacterium chelonae infection following liposuction. Clin Infect Dis. 2002;34:1500–7.

    PubMed  Article  Google Scholar 

  4. Chandra NS, Torres MF, Winthrop KL, Bruckner DA, Heidemann DG, Calvet HM, et al. A cluster of Mycobacterium chelonae keratitis cases following laser in situ keratomileusis. Am J Ophtalmol. 2001;132:819–30.

    Article  CAS  Google Scholar 

  5. Ingram CW, Tanner DC, Durack DT, Kernodle GW Jr, Corey GR. Disseminated infection with rapidly growing mycobacteria. Clin Infect Dis. 1993;16:463–71.

    PubMed  Article  CAS  Google Scholar 

  6. Ellison D, Love S, Chimelli L, Harding BN, Lowe J, Vinters HV. Calcium disturbances and Fahr’s disease. In: Ellison D, Love S, editors. Neuropathology: a reference text of CNS pathology. London: Elsevier Science; 2004. p. 428–9.

    Google Scholar 

  7. Wallace RJ Jr, Tanner D, Brennan PI, Brown BA. Clinical trial of clarithromycin for cutaneous (disseminated) infection due to Mycobacterium chelonae. Ann Intern Med. 1993;119:482–6.

    PubMed  Google Scholar 

  8. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, et al. on behalf of the ATS Mycobacterial diseases subcommittee. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007;175:367–416.

    PubMed  Article  CAS  Google Scholar 

  9. Piersimoni C, Scaparo C. Extrapulmonary infections associated with nontuberculous mycobacteria in immunocompetent persons. Emerg Infect Dis. 2009;15:1351–135.

    Google Scholar 

  10. Vemulapalli RK, Cantey JR, Steed LL, Knapp TL, Thielman NM. Emergence of resistance to clarithromycin during treatment of disseminated cutaneous Mycobacterium chelonae infection: case report and literature review. J Infect. 2001;43(3):163–8.

    PubMed  Article  CAS  Google Scholar 

  11. Yang SC, Hsueh PR, Lai HC, Teng LJ, Huuang LM, Chen JM, et al. High prevalence of antimicrobial resistance in rapidly growing mycobacteria in Taiwan. Antimicrob Agents Chemother. 2003;47:1958–62.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mateja Jankovic.

About this article

Cite this article

Jankovic, M., Zmak, L., Krajinovic, V. et al. A fatal Mycobacterium chelonae infection in an immunosuppressed patient with systemic lupus erythematosus and concomitant Fahr’s syndrome. J Infect Chemother 17, 264–267 (2011). https://doi.org/10.1007/s10156-010-0110-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10156-010-0110-4

Keywords

  • Mycobacterium chelonae
  • Systemic lupus erythematosus
  • Fahr’s syndrome
  • Nontuberculous mycobacteria