eMedicine Specialties > Dermatology > Mycobacterial Infections

Atypical Mycobacterial Diseases: Differential Diagnoses & Workup

Author: Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice
Contributor Information and Disclosures

Updated: Mar 21, 2008

Differential Diagnoses

Actinomycosis
Papulonecrotic Tuberculids
Cellulitis
Pyoderma Gangrenosum
Coccidioidomycosis
Sarcoidosis
Cutaneous Manifestations of HIV Disease
Sporotrichosis
Erythema Induratum (Nodular Vasculitis)
Wegener Granulomatosis
Mycobacterium Avium-Intracellulare Infection
Yaws
Mycobacterium Marinum Infection of the Skin

Other Problems to Be Considered

In 2007, Perrin24 described a patient with AIDS and a cutaneous M avium-intracellulare infection mimicking histoid leprosy.

Workup

Laboratory Studies

  • The optimal way to diagnosis ATM is by performing a culture of tissue. This should be performed at multiple temperatures 25°, 37°, and 42° to ensure that the cultures grow out all possible pathogens.
  • The development of DNA fingerprinting technology, especially pulsed-field gel electrophoresis, has been suggested as a diagnostic tool. Polymerase chain reaction has been used to aid in diagnosing these conditions.

Imaging Studies

  • In 1999, Erasmus et al25 noted that the radiologic manifestations of pulmonary ATM infection are protean and include consolidation, cavitation, fibrosis, nodules, bronchiectasis, and adenopathy.
    • Pulmonary ATM infection has 5 distinct clinicoradiologic manifestations: classic infection, nonclassic infection, nodules in patients who are asymptomatic, infection in patients with achalasia, and infection in patients who are immunocompromised. Although classic ATM infection may be indistinguishable from active tuberculosis, it is usually more indolent.
    • The characteristic radiologic features of nonclassic ATM infection include bronchiectasis and centrilobular nodules isolated to or most severe in the lingula and the middle lobe. In patients with acquired immunodeficiency syndrome, mediastinal or hilar adenopathy is the most common radiographic finding.

Other Tests

  • The purified protein derivative test result is usually negative in infections with ATM.

Procedures

  • A biopsy of the skin, the cervical nodes, and the lung can be used to diagnose ATM. The tissue obtained can be used for cultures of the tissue and for histopathologic examination.

Histologic Findings

Histopathologic examination of tissue can reveal tuberculoid, palisading, and sarcoidlike granulomas; a diffuse infiltrate of histiocytic foamy cells; acute and chronic panniculitis; nonspecific chronic inflammation; cutaneous abscesses; suppurative granulomas; and necrotizing folliculitis. Suppurative granulomas are the most characteristic feature in skin biopsy specimens from cutaneous ATM infections. The evolution of the disease and the immunologic status of the host may explain this spectrum of morphologic changes.

Some authorities note severe inflammatory lesions involved with the dermis and the hypodermis; these can have 3 main histopathologic patterns: granulomatous nodular or diffuse inflammation with mixed granulomas, prevailing abscesses with mild granulomatous reaction, and deep dermal and subcutaneous granulomatous inflammation with no neutrophil component.

More on Atypical Mycobacterial Diseases

Overview: Atypical Mycobacterial Diseases
Differential Diagnoses & Workup: Atypical Mycobacterial Diseases
Treatment & Medication: Atypical Mycobacterial Diseases
Follow-up: Atypical Mycobacterial Diseases
References
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References

  1. Horsburgh CR Jr. Epidemiology of disease caused by nontuberculous mycobacteria. Semin Respir Infect. Dec 1996;11(4):244-51. [Medline].

  2. Czelusta A, Moore AY. Cutaneous Mycobacterium kansasii infection in a patient with systemic lupus erythematosus: case report and review. J Am Acad Dermatol. Feb 1999;40(2 Pt 2):359-63. [Medline].

  3. Hsu PY, Yang YH, Hsiao CH, Lee PI, Chiang BL. Mycobacterium kansasii infection presenting as cellulitis in a patient with systemic lupus erythematosus. J Formos Med Assoc. Aug 2002;101(8):581-4. [Medline].

  4. Murillo J, Torres J, Bofill L, Ríos-Fabra A, Irausquin E, Istúriz R, et al. Skin and wound infection by rapidly growing mycobacteria: an unexpected complication of liposuction and liposculpture. The Venezuelan Collaborative Infectious and Tropical Diseases Study Group. Arch Dermatol. Nov 2000;136(11):1347-52. [Medline].

  5. Sañudo A, Vallejo F, Sierra M, Hoyos JG, Yepes S, Wolff JC, et al. Nontuberculous mycobacteria infection after mesotherapy: preliminary report of 15 cases. Int J Dermatol. Jun 2007;46(6):649-53. [Medline].

  6. Vinh DC, Rendina A, Turner R, Embil JM. Breast implant infection with Mycobacterium fortuitum group: report of case and review. J Infect. Mar 2006;52(3):e63-7. [Medline].

  7. Murdoch DM, McDonald JR. Mycobacterium avium-intracellulare cellulitis occurring with septic arthritis after joint injection: a case report. BMC Infect Dis. Feb 2007;7:9. [Medline].

  8. Safranek TJ, Jarvis WR, Carson LA, Cusick LB, Bland LA, Swenson JM, et al. Mycobacterium chelonae wound infections after plastic surgery employing contaminated gentian violet skin-marking solution. N Engl J Med. Jul 23 1987;317(4):197-201. [Medline].

  9. Centers for Disease Control and Prevention. Infection with Mycobacterium abscessus associated with intramuscular injection of adrenal cortex extract--Colorado and Wyoming, 1995-1996. JAMA. Oct 9 1996;276(14):1130. [Medline].

  10. Burke DS, Ullian RB. Megaesophagus and pneumonia associated with Mycobacterium chelonei. A case report and a literature review. Am Rev Respir Dis. Dec 1977;116(6):1101-7. [Medline].

  11. Sungkanuparph S, Sathapatayavongs B, Pracharktam R. Rapidly growing mycobacterial infections: spectrum of diseases, antimicrobial susceptibility, pathology and treatment outcomes. J Med Assoc Thai. Aug 2003;86(8):772-80. [Medline].

  12. Redbord KP, Shearer DA, Gloster H, Younger B, Connelly BL, Kindel SE, et al. Atypical Mycobacterium furunculosis occurring after pedicures. J Am Acad Dermatol. Mar 2006;54(3):520-4. [Medline].

  13. Hoetzenecker W, Ulmer A, Klingel K, Kempf VA, Schanz S, Metzler G, et al. Dissemination of a localized cutaneous infection with Mycobacterium chelonae under immunosuppressive treatment. Arch Dermatol. Jul 2007;143(7):951-2. [Medline].

  14. Frisk P, Boman G, Pauksen K, Petrini B, Lönnerholm G. Skin infection caused by Mycobacterium szulgai after allogeneic bone marrow transplantation. Bone Marrow Transplant. Mar 2003;31(6):511-3. [Medline].

  15. Murray-Leisure KA, Egan N, Weitekamp MR. Skin lesions caused by Mycobacterium scrofulaceum. Arch Dermatol. Mar 1987;123(3):369-70. [Medline].

  16. Sowers WF. Swimming pool granuloma due to Mycobacterium scrofulaceum. Arch Dermatol. May 1972;105(5):760-1. [Medline].

  17. Wada A, Nomura S, Ihara F. Mycobacterium kansaii flexor tenosynovitis presenting as carpal tunnel syndrome. J Hand Surg [Br]. Jun 2000;25(3):308-10. [Medline].

  18. Bernard L, Vincent V, Lortholary O, Raskine L, Vettier C, Colaitis D, et al. Mycobacterium kansasii septic arthritis: French retrospective study of 5 years and review. Clin Infect Dis. Dec 1999;29(6):1455-60. [Medline].

  19. Callahan EF, Licata AL, Madison JF. Cutaneous Mycobacterium kansasii infection associated with a papulonecrotic tuberculid reaction. J Am Acad Dermatol. Mar 1997;36(3 Pt 1):497-9. [Medline].

  20. Drabick JJ, Hoover DL, Roth RE, Sauri MA, Apgar RG. Ulcerative perineal lesions due to Mycobacterium kansasii. J Am Acad Dermatol. May 1988;18(5 Pt 1):1146-7. [Medline].

  21. Demitsu T, Nagato H, Inoue T, Yoneda K, Fujiwara Y, Miura M, et al. Cutaneous Mycobacterium chelonae infection with bilateral sporotrichoid involvement. Int J Dermatol. Sep 2001;40(9):597-9. [Medline].

  22. Lee WJ, Kim TW, Shur KB, Kim BJ, Kook YH, Lee JH, et al. Sporotrichoid dermatosis caused by Mycobacterium abscessus from a public bath. J Dermatol. Apr 2000;27(4):264-8. [Medline].

  23. Pai HH, Chen WC, Peng CF. Isolation of non-tuberculous mycobacteria from hospital cockroaches (Periplaneta americana). J Hosp Infect. Mar 2003;53(3):224-8. [Medline].

  24. Perrin C. A patient with acquired immunodeficiency syndrome (AIDS) and a cutaneous Mycobacterium avium intracellulare infection mimicking histoid leprosy. Am J Dermatopathol. Aug 2007;29(4):422. [Medline].

  25. Erasmus JJ, McAdams HP, Farrell MA, Patz EF Jr. Pulmonary nontuberculous mycobacterial infection: radiologic manifestations. Radiographics. Nov-Dec 1999;19(6):1487-505. [Medline].

  26. Jousse-Joulin S, Garre M, Guennoc X, Destombe C, Samjee I, Devauchelle-Pensec V, et al. Skin and joint infection by Mycobacterium chelonae: rescue treatment with interferon gamma. Joint Bone Spine. Jul 2007;74(4):385-8. [Medline].

  27. Han XY, Dé I, Jacobson KL. Rapidly growing mycobacteria: clinical and microbiologic studies of 115 cases. Am J Clin Pathol. 2007 Oct;128(4):612-21. [Medline].

  28. Ali S, Sivak-Callcott JA, Khakoo R, Williams HJ. Mycobacterium fortuitum infection masquerading as an orbital mass. Ophthal Plast Reconstr Surg. Jul-Aug 2007;23(4):327-9. [Medline].

  29. Bartralot R, Pujol RM, García-Patos V, Sitjas D, Martín-Casabona N, Coll P, et al. Cutaneous infections due to nontuberculous mycobacteria: histopathological review of 28 cases. Comparative study between lesions observed in immunosuppressed patients and normal hosts. J Cutan Pathol. Mar 2000;27(3):124-9. [Medline].

  30. Bormann G, Marsch WC. [Sporotrichoid atypical mycobacterial infections. Antibiotic monotherapy]. Hautarzt. Mar 2004;55(3):292-5. [Medline].

  31. Brantley JS, Readinger AL, Morris ES. Cutaneous Infection with Mycobacterium abscessus in a child. Pediatr Dermatol. Mar-Apr 2006;23(2):128-31. [Medline].

  32. Camargo D, Saad C, Ruiz F, Ramirez ME, Lineros M, Rodriguez G, et al. Iatrogenic outbreak of M. chelonae skin abscesses. Epidemiol Infect. Aug 1996;117(1):113-9. [Medline].

  33. Chaves A, Torrelo A, Mediero IG, Menéndez-Rivas M, Ortega-Calderón A, Zambrano A. Primary cutaneous Mycobacterium kansasii infection in a child. Pediatr Dermatol. Mar-Apr 2001;18(2):131-4. [Medline].

  34. Cookson BD, Dunger D. Mycobacterium szulgai--a case of cutaneous infection?. Tubercle. Mar 1985;66(1):65-7. [Medline].

  35. Cross GM, Guill MA, Aton JK. Cutaneous Mycobacterium szulgai infection. Arch Dermatol. Feb 1985;121(2):247-9. [Medline].

  36. Curcó N, Pagerols X, Gómez L, Vives P. Mycobacterium kansasii infection limited to the skin in a patient with AIDS. Br J Dermatol. Aug 1996;135(2):324-6. [Medline].

  37. dos Santos VM, Noronha FL, Vicentina EC, Lima CC. Mycobacterium ulcerans infection in Brazil. Med J Aust. Jul 2007;187(1):63-4. [Medline].

  38. Fitzgerald DA, Smith AG, Lees A, Yee L, Cooper N, Harris SC, et al. Cutaneous infection with Mycobacterium abscessus. Br J Dermatol. May 1995;132(5):800-4. [Medline].

  39. Francis G, Whitby M, Woods M. Mycobacterium ulcerans infection: a rediscovered focus in the Capricorn Coast region of central Queensland. Med J Aust. Aug 7 2006;185(3):179-80. [Medline].

  40. Griffith DE. Management of disease due to Mycobacterium kansasii. Clin Chest Med. Sep 2002;23(3):613-21, vi. [Medline].

  41. Gur H, Porat S, Haas H, Naparstek Y, Eliakim M. Disseminated mycobacterial disease caused by Mycobacterium szulgai. Arch Intern Med. Sep 1984;144(9):1861-3. [Medline].

  42. Hisamichi K, Hiruma M, Yamazaki M, Matsushita A, Ogawa H. Efficacy of oral minocycline and hyperthermic treatment in a case of atypical mycobacterial skin infection by Mycobacterium marinum. J Dermatol. Dec 2002;29(12):810-1. [Medline].

  43. Jackson PG, Keen H, Noble CJ, Simmons NA. Injection abscesses in a diabetic due to Mycobacterium chelonei var abscessus. Br Med J. Oct 25 1980;281(6248):1105-6. [Medline].

  44. Martinez G, Bizcarguenaga J, Agurruza JM, Rezusta A, Carapeto FJ. [Cutaneous mycobacteriosis caused by Mycobacterium chelonei var. abscessus]. Med Cutan Ibero Lat Am. 1988;16(3):197-200. [Medline].

  45. Morris-Jones R, Fletcher C, Morris-Jones S, Brown T, Hilton RM, Hay R. Mycobacterium abscessus: a cutaneous infection in a patient on renal replacement therapy. Clin Exp Dermatol. Jul 2001;26(5):415-8. [Medline].

  46. Mueller PS, Edson RS. Disseminated Mycobacterium abscessus infection manifesting as fever of unknown origin and intra-abdominal lymphadenitis: case report and literature review. Diagn Microbiol Infect Dis. Jan 2001;39(1):33-7. [Medline].

  47. Nakagawa K, Tsuruta D, Ishii M. Successful treatment of a widespread cutaneous Mycobacterium fortuitum infection with levofloxacin. Int J Dermatol. Sep 2006;45(9):1098-9. [Medline].

  48. Nelson BR, Rapini RP, Wallace RJ Jr, Tschen JA. Disseminated Mycobacterium chelonae ssp. abscessus in an immunocompetent host and with a known portal of entry. J Am Acad Dermatol. May 1989;20(5 Pt 2):909-12. [Medline].

  49. Palwade PK, Dhurat RS, Tendolkar UM, Dethe GR, Jerajani HR. Chronic cutaneous disease caused by the rapid growers Mycobacterium fortuitum and chelonae. Br J Dermatol. Apr 2006;154(4):774-5. [Medline].

  50. Passeron T, Desruelles F, Fosse T, Weiller M, Perrin C, Lacour JP, et al. Disseminated papulopustular eruption due to Mycobacterium fortuitum in an immunocompetent patient. Clin Infect Dis. Apr 1999;28(4):924-5. [Medline].

  51. Plaus WJ, Hermann G. The surgical management of superficial infections caused by atypical mycobacteria. Surgery. Jul 1991;110(1):99-103. [Medline].

  52. Prinz BM, Michaelis S, Kettelhack N, Mueller B, Burg G, Kempf W. Subcutaneous infection with Mycobacterium abscessus in a renal transplant recipient. Dermatology. 2004;208(3):259-61. [Medline].

  53. Razavi B, Cleveland MG. Cutaneous infection due to Mycobacterium kansasii. Diagn Microbiol Infect Dis. Nov 2000;38(3):173-5. [Medline].

  54. Rodríguez G, Ortegón M, Camargo D, Orozco LC. Iatrogenic Mycobacterium abscessus infection: histopathology of 71 patients. Br J Dermatol. Aug 1997;137(2):214-8. [Medline].

  55. Rovery C, Rolain JM, Lepidi H, Zandotti C, Moreau J, Brouqui P. Bartonella quintana coinfection with Mycobacterium avium complex and CMV in an AIDS patient: case presentation. BMC Infect Dis. 2006;6:89. [Medline].

  56. S Breza T Jr, Magro CM. Lichenoid and granulomatous dermatitis associated with atypical mycobacterium infections. J Cutan Pathol. Jul 2006;33(7):512-5. [Medline].

  57. Stellbrink HJ, Koperski K, Albrecht H, Greten H. Mycobacterium kansasii infection limited to skin and lymph node in a patient with AIDS. Clin Exp Dermatol. Nov 1990;15(6):457-8. [Medline].

  58. Stengem J, Grande KK, Hsu S. Localized primary cutaneous Mycobacterium kansasii infection in an immunocompromised patient. J Am Acad Dermatol. Nov 1999;41(5 Pt 2):854-6. [Medline].

  59. Stragier P, Ablordey A, Bayonne LM, Lugor YL, Sindani IS, Suykerbuyk P, et al. Heterogeneity among Mycobacterium ulcerans isolates from Africa. Emerg Infect Dis. May 2006;12(5):844-7. [Medline].

  60. Swetter SM, Kindel SE, Smoller BR. Cutaneous nodules of Mycobacterium chelonae in an immunosuppressed patient with preexisting pulmonary colonization. J Am Acad Dermatol. Feb 1993;28(2 Pt 2):352-5. [Medline].

  61. Sybert A, Tsou E, Garagusi VF. Cutaneous infection due to mycobacterium szulgai. Am Rev Respir Dis. Apr 1977;115(4):695-8. [Medline].

  62. Taylor JL, Palmer SM. Mycobacterium abscessus chest wall and pulmonary infection in a cystic fibrosis lung transplant recipient. J Heart Lung Transplant. Aug 2006;25(8):985-8. [Medline].

  63. Tsai HC, Lee SS, Wann SR, Chen YS, Liu YW, Liu YC. Mycobacterium marinum tenosynovitis: three case reports and review of the literature. Jpn J Infect Dis. Oct 2006;59(5):337-40. [Medline].

  64. Valero G, Peters J, Jorgensen JH, Graybill JR. Clinical isolates of Mycobacterium simiae in San Antonio, Texas. An 11-yr review. Am J Respir Crit Care Med. Nov 1995;152(5 Pt 1):1555-7. [Medline].

  65. Vandercam B, Gala J, Vandeweghe B, Degraux J, Wauters G, Larsson L, et al. Mycobacterium simiae disseminated infection in a patient with acquired immunodeficiency syndrome. Infection. Jan-Feb 1996;24(1):49-51. [Medline].

  66. Vogels MT, Tjan-Heijnen VC, Alkemade JA, Beex LV, Muytjens HL. Cutaneous infection due to Mycobacterium abscessus. A case report. Acta Derm Venereol. May 1997;77(3):222-4. [Medline].

  67. Wagner D, Young LS. Nontuberculous mycobacterial infections: a clinical review. Infection. Oct 2004;32(5):257-70. [Medline].

  68. Wallace RJ Jr. Recent changes in taxonomy and disease manifestations of the rapidly growing mycobacteria. Eur J Clin Microbiol Infect Dis. Nov 1994;13(11):953-60. [Medline].

  69. Wallace RJ Jr, Swenson JM, Silcox VA, Good RC, Tschen JA, Stone MS. Spectrum of disease due to rapidly growing mycobacteria. Rev Infect Dis. Jul-Aug 1983;5(4):657-79. [Medline].

  70. Ward JM. M. fortuitum and M. chelonei-fast growing mycobacteria. A review with a case report. Br J Dermatol. Apr 1975;92(4):453-9. [Medline].

  71. Wiegell SR, Kongshoj B, Wulf HC. Mycobacterium marinum infection cured by photodynamic therapy. Arch Dermatol. Sep 2006;142(9):1241-2. [Medline].

  72. Wolf R, Wolf D. A tattooed butterfly as a vector of atypical Mycobacteria. J Am Acad Dermatol. May 2003;48(5 Suppl):S73-4. [Medline].

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Further Reading

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Keywords

atypical mycobacterial infection, ATM, AMI, nontypical mycobacterial infections, NTM, NTMI, Mycobacterium kansasii, M kansasii, Mycobacterium genavense, M genavense, Mycobacterium marinum, M marinum, Mycobacterium simiae, M simiae, Mycobacterium scrofulaceum, M scrofulaceum, Mycobacterium szulgai, M szulgai, Mycobacterium avium, M avium, Mycobacterium haemophilum, M haemophilum, Mycobacterium intracellulare, M intracellulare, Mycobacterium malmoense, M malmoense, Mycobacterium ulcerans, M ulcerans, Mycobacterium xenopi, M xenopi, Mycobacterium abscessus, M abscessus, Mycobacterium chelonae, M chelonae, Mycobacterium fortuitum, M fortuitum, Mycobacterium smegmatis, M smegmatis, Mycobacterium avium-intracellulare complex, M avium-intracellulare complex

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Contributor Information and Disclosures

Author

Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice
Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Optigenex Consulting fee Independent contractor

Medical Editor

Takeji Nishikawa, MD, Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan Inc
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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