Disseminated infection with the rapidly growing mycobacteria Mycobacterium chelonae and Mycobacterium fortuitum is uncommon. Only eight cases were diagnosed at Duke University Medical Center (Durham, NC) over the last 14 years. We identified 46 other cases by review of the medical literature since 1960. We categorized these 54 cases into three groups according to underlying disease and outcome. Group 1 comprised patients with no identified immune defect, a kidney transplant, collagen vascular disease, or chronic renal failure; these patients usually presented with skin involvement and responded well to antimicrobial therapy (survival rate, 90%). Group 2 comprised patients with cell-mediated immune deficiency, lymphoma, or leukemia; they presented with widespread, multiorgan involvement and severe illness. The survival rate in this group was only 10%. Patients in group 3 (who had other underlying diseases) had intermediately severe illnesses and intermediate responses to therapy. These groups provide the basis for an understanding of disseminated infection secondary to rapidly growing mycobacteria and of the profound effect that unresolved immunosuppression has on survival.

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A 54-year-old black man developed acute pain and swelling of the manubriosternal joint. Acute gouty arthritis was diagnosed by arthrocentesis and polarizing microscopy. The histology of the manubriosternal joint and its involvement in other arthritides are briefly discussed.Acute gout may involve the chest wall by agecting the sternoclavicular (1,2) or the costochondral articulation (1). We describe a patient who presented with an acute monarticular manubriosternal arthritis as his initial manifestation of gout.Case report. The patient, a 54-year-old black man, presented to the Duke University Medical Center emergency room with an 18-hour history of tenderness and mild swelling over the upper sternum. He complained of pain in his mid-anterior chest wall with any motion of his shoulders or with deep inspiration.He: denied trauma, recent exertion, alcohol ingestion, fever, or any rheumatic complaints.His other medical problems included noninsulin-dependent diabetes mellitus, hypertension treated with thiazide diuretics, and mild renal insufficiency (creatinine 2.1 mg/dl). A previous uric acid determination was noted to be 9.6 mg/dl. He denied any history of acute or chronic arthritis. One year previously, he had been hospitalized for acute chest --__