DisseminatedMycobacterium haemophiluminfection in a 72-year-old patient with rheumatoid arthritis on infliximab

Abstract

Mycobacterium haemophilumis a slow growing, aerobic, fastidious mycobacterium requiring hemin and a temperature of 30–32° C for optimal growth that is ubiquitous in nature. Disease in immunocompromised adults typically manifests as skin lesions such as papules, pustules and ulcerations. This organism also causes lymphadenitis in immunocompetent children. Antitumour necrosis factor-α (anti-TNF-α) therapy with agents such as infliximab, etanercept and adalimumab is increasingly being used for immunosuppression in patients with various autoimmune conditions. These agents are known to place patients at increased risk for tuberculosis and other granulomatous diseases. However, little is known about illness caused byM haemophilumin patients on immunosuppression with anti-TNF-α therapy. We describe a case of disseminatedM haemophilummanifesting as skin lesions in a 72-year-old man with rheumatoid arthritis on infliximab and methotrexate.

Therapeutic potential of IL-15 in rheumatoid arthritis

“…However, skin cancers were increased among RA patients with anti-TNF therapy [76]. In addition, anti-TNF-α therapy may cause disseminated Mycobacterium haemophilum infection manifesting as skin lesions in RA patients [77].…”

Rheumatoid Arthritis Increases the Risk of Nontuberculosis Mycobacterial Disease and Active Pulmonary Tuberculosis

“…The chronic use of methotrexate (MTX) to treat RA can result in opportunistic infections such as pulmonary nontuberculosis mycobacterium (NTM) disease [6] . One study observed NTM disease in immunosuppressed RA patients using anti-TNF-alpha therapy [7] . Yamakawa et al showed disease deterioration because of an antirheumatic drug received during NTM disease follow-up [8] .…”

Disseminated Mycobacterium haemophilum skeletal disease in a patient with interferon‐gamma deficiency

“…Among those with specific predisposition, disseminated skeletal disease is a rare occurrence . Severe NTM infections have been mainly reported in persons with impaired cell‐mediated immunity, as seen in human immunodeficiency virus (HIV/AIDS) infection, primary T‐cell deficiencies and complications of immunosuppressive drugs including monoclonal antibody agents (anti CD52, anti TNF‐α) . These were not implicated in this case.…”

“…2 Severe NTM infections have been mainly reported in persons with impaired cell-mediated immunity, as seen in human immunodeficiency virus (HIV/AIDS) infection, primary T-cell deficiencies and complications of immunosuppressive drugs including monoclonal antibody agents (anti CD52, anti TNF-α). 2,4,5 These were not implicated in this case. Other known reported genetic predispositions include the Mendelian susceptibility to mycobacterial diseases (MSMD).…”