Atypical Mycobacteriosis During TNF Blockade

A 47-year-old man was referred by his rheumatologist to our dermatological outpatient service. Over the past year, despite external local treatments, antibiotics, and surgery, he had experienced recurring ulcerations of his left hand, originating from the index finger. There were palpable subcutaneous foci on the left arm. He was a construction worker and had washed his hands in a tub of water from a flooded gravel-pit. For the past 18 months he had been receiving adalimumab to treat Bechterev disease. Histological tissue processing revealed a granulomatous inflammatory reaction, while polymerase chain reaction and tissue microscopy showed no abnormality. However, a 3-week microbiological culture was positive for Mycobacterium marinum. In accordance with the patient’s antibiogram, we treated him for several months with clarithromycin, rifabutin, and ethambutol, discontinuing the adalimumab. The lesions healed with this treatment. M. marinum is a non-tuberculous mycobacterium that can cause cutaneous and systemic infection and is predominantly associated with aquarium contact. TNF-alpha blockade may facilitate infection.

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Matthias D. Kaufmann, PD Dr. med. Cornelia Erfurt-Berge, Dr. med. Petra Wörl, Hautklinik, Universitätsklinikum Erlangen, [e-mail]

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Kaufmann MD, Erfurt-Berge C, Wörl P: Atypical mycobacteriosis during TNF blockade. Dtsch Arztebl Int 2022; 119: 372. DOI: 10.3238/arztebl.m2022.0051