Mycobacterium haemophilum skin and soft tissue infection in a kidney transplant recipient: A case report and summary of the literature

Abstract

Mycobacterium haemophilum is a slow-growing non-tuberculous mycobacterium (NTM) that preferentially grows at lower temperatures (30-32°C) and requires iron or hemin supplementation. The organism was initially identified in 1978 from the ulcers of a patient with Hodgkin's disease who was receiving immunosuppressive therapy. 1 Similarly to Mycobacterium leprae, M haemophilum expresses phenolic glycolipid antigens and contains docosanoic acid. 2 Patients with M haemophilum infection typically present with localized cutaneous infection or cervicofacial lymphadenitis. However, both localized and disseminated infection can occur in patients with primary genetic or acquired immunodeficiencies (eg, anti-interferon-gamma autoantibodies, GATA2 deficiency, or HIV/AIDS). Transplant recipients can also be affected and typically present with painless erythematous papules that subsequently ulcerate and form an abscess. 3 Rarely, M haemophilum can cause deep soft tissue infection leading to septic arthritis, pyomyositis, osteomyelitis, or metastatic infection at distant sites (eg, endophthalmitis, pulmonary nodules, or epididymal abscess). 4,5 Herein, we present the case of a kidney transplant recipient with deep soft tissue infection caused by M haemophilum, confirmed by molecular testing, who presented with unilateral cellulitis-like lesions complicated by tenosynovitis and abscess formation. We also conducted a literature review to document previous cases of transplant recipients affected by this pathogen.

Mycobacterial skin infection

“…Potentially all NTM species can cause skin infections; however, for the slow growing mycobacterium (SGM) M. marinum , the skin is the typical site of infection, and the rapidly growing mycobacteria (RGM) M. fortuitum , M. abscessus and M. chelonae may also give cutaneous disease. MAC complex [ 44 ] and less pathogenic NTM may also determine SSTIs, as reported for M. haemophilum [ 7 , 45 , 46 ], M. gordonae [ 47 ] and M. agri [ 48 ].…”