Eruptions in a patient with Crohn’s disease using infliximab:
Culture revealed M.marinum, with positive IGRA (results were negative previously)
- Oppoturnistic bacteria that causes aquarium granuloma (affects individuals who work with fish or have aquarium at home).
- Most are acquired during the handling of the aquariums such as cleaning or changing the water.
- Typically affects hands, but can also affect knees and legs in swimming pool related cases.
- Commonly happened in immunosuppressed patients
– TNF-a inhibitors suppress cellular immunity.
- Commonly misdiagnosed. Can mimic sporotrichosis by evolving into ascending lymphangitis.
- Rx: takes a long time; treatment should be continued 1-2 months after resolution of symptoms (=3-4 months in total)
– 2 antibiotics needed: clarithromycin + ethambutol; rifampin can be added if there is deep tissues involvement
– Also sensitive to doxycycline, ciprofloxacin and sulfonamides.
– Resistance to isoniazid and pyrazinamide.
- The use of TNF-α inhibitors is widespread, and the presence of sporotrichoid eruptions in these patients should suggest the possibility of mycobacterial infection.
- Jessica Kim So, M.D., and Taraneh Paravar, M.D. Sporotrichoid Mycobacterial Infection. N Engl J Med 2015; 373:1761