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Mycobacterium avium-intracellulare pulmonary infection complicated by cutaneous leukocytoclastic vasculitis in a woman with anorexia nervosa

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Abstract

A 53-year-old Caucasian woman with a history of anorexia nervosa developed a bilateral lower extremity rash comprised of palpable red to violaceous, sub-centimeter papular lesions that increased in quantity rapidly. She also noted a 2-month history of non-productive cough. Imaging modalities revealed a thin-walled cavitary lesion in the right lung apex and scattered nodular opacities. Acid fast bacilli (AFB) were found in sputum and subsequently identified by culture as Mycobacterium avium-intracellulare (MAI). Punch biopsies of her skin lesions yielded a histological diagnosis of small-to-medium vessel vasculitis. Stains and cultures for organisms were negative. Her skin lesions resolved quickly after the initiation of antimicrobial therapy for MAI. Hypersensitivity vasculitis associated with an atypical mycobacterial infection is unusual. The postulated underlying mechanism is the deposit of immune complexes and not the bacillus itself. While cutaneous leukocytoclastic vasculitis (CLV) due to MAI is certainly a rare entity, it should be entertained in patients with vasculitic skin lesions and a concomitant pulmonary disease.

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Abbreviations

AFB:

Acid fast bacilli

ANA:

Anti-nuclear antibody

ANCA:

Anti-neutrophil cytoplasmic antibody

BMI:

Body mass index

CLV:

Cutaneous leukocytoclastic vasculitis

cm:

Centimeter

CT:

Computed tomography

dL:

Deciliter

ELISA:

Enzyme-linked immunosorbent assay

gm:

Gram

HIV:

Human immunodeficiency virus

kg:

Kilogram

NTM:

Non-tubercular mycobacteria

MAI:

Mycobacterium avium-intracellulare

mg:

Milligram

mm:

Millimeter

mm3 :

Cubic millimeter

MPO:

Myeloperoxidase

pANCA:

Perinuclear anti-neutrophil cytoplasmic antibody

TB:

Mycobacterium tuberculosis

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Division of Infectious Diseases, University of Pittsburgh Medical Center, Falk Medical Building, Suite 3A, 3601 Fifth Avenue, Pittsburgh, PA, 15213, USA

    T. L. Walsh & P. J. Veldkamp

  2. Department of Medicine, Allegheny General Hospital, Internal Medicine Residency Department, 7th Floor, 320 East North Avenue, Pittsburgh, PA, 15212, USA

    V. Baca

  3. Department of Dermatology, University of Pittsburgh Medical Center, Presbyterian South Tower, Suite 3880, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    S. S. Stalling & A. A. Natalie

Authors
  1. T. L. Walsh
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  2. V. Baca
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  3. S. S. Stalling
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  4. A. A. Natalie
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  5. P. J. Veldkamp
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Correspondence to T. L. Walsh.

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Walsh, T.L., Baca, V., Stalling, S.S. et al. Mycobacterium avium-intracellulare pulmonary infection complicated by cutaneous leukocytoclastic vasculitis in a woman with anorexia nervosa. Infection 42, 559–563 (2014). https://doi.org/10.1007/s15010-013-0574-0

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  • DOI: https://doi.org/10.1007/s15010-013-0574-0

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