Mycobacterium Haemophilum Clinical Presentation

Updated: Oct 07, 2015
  • Author: Natalie C Klein, MD, PhD; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
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Presentation

History

Lymphadenitis in children

The most common symptom is swelling of the neck, which slowly enlarges over several weeks to months. The enlarged nodes may be painful. A course of antimicrobial therapy (eg, 2 wk of oral amoxicillin/clavulanic acid) does not cure the swelling.

Inguinal lymphadenitis has also been reported. [8]

Systemic symptoms are absent except for low-grade fever.

Lymphadenitis in adults

Six cases have occurred in immunocompetent adults. [9]

Cervicofacial lymphadenitis has been reported in immunocompromised adults. [10]

Skin lesions

Skin lesions are the most common presenting symptom in immunosuppressed patients.

Lesions usually develop on the extremities over joints. They may begin as papules, subcutaneous nodules, scales, or cysts and are initially painless but often become tender and pruritic. Painful ulcerations may occur. Erythema may surround the lesion.

Lesions may resemble sporotrichosis. [11]

Oculofacial lesions have been reported in an immunocompetent child. [12]

Erythematous plaques and subcutaneous nodules of the face mimicking leprosy have been reported. [13, 14]

Nodular skin lesions have occurred after permanent tattooing of eyebrows in 2 women. [15]

Tattoo-associated skin lesions have occurred in immunocompetent adults [16]

Skin lesions have been reported prior to onset of B cell lymphoma in a liver transplant recipient. [17]

Septic arthritis

Patients present with pain and swelling over a joint, usually the knee or elbow. Often, the patient has a history of cutaneous lesions overlying the joint.

Pyomyositis

This has been reported in a renal transplant recipient. [18]

Osteomyelitis

This is reported in patients with AIDS.

Skin lesions are usually present.

Septic arthritis is usually present.

Pneumonia

Symptoms include fever, cough, pleuritic chest pain, and dyspnea.

Patients may have a history of treated cutaneous lesions.

This is reported in bone marrow transplant recipients and patients with AIDS. [19, 20, 21]

Central venous catheter tunnel infection

Two cases in immunosuppressed patients have been reported. The first patient presented with a supraclavicular mass with overlying cellulitis that progressed to ulceration. The second patient had an ulceration and purulent discharge at the former site of a Hickman catheter. [22]

Chronic cutaneous granulomata

One case was described in a previously healthy man following a coral injury in Thailand. [23]

Endophthalmitis

This has been reported in a cardiac transplant patient. [24]

Epididymal abscess

This has been reported in a renal transplant patient. [25]

Central nervous system infection

This has been reported in patients with AIDS. [26, 27]

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Physical

Lymphadenitis

The submandibular and cervical nodes are most frequently involved. Perihilar nodes are involved less frequently. Enlarged nodes are usually unilateral and may be tender and fluctuant. Overlying skin may be erythematous.

Low-grade fever may be present.

Skin lesions

Lesions include the following:

  • Papules
  • Subcutaneous abscesses
  • Nodules
  • Cysts
  • Scaly plaques
  • Ulcers

Initially, they are painless but may become painful or pruritic.

They may be localized on extremities over joints, or they may be diffuse.

Septic arthritis

The major finding is a swollen fluctuant knee.

Osteomyelitis

Septic arthritis is also present.

Pneumonia

Fever is present.

Central venous catheter tunnel infection

Ulcerations develop at the exit site and along the catheter track.

Lymphadenopathy

Lymphadenopathy may occur.

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Causes

Risk factors for M haemophilum infection include the following:

  • HIV/AIDS
  • Immunosuppression [28, 29, 30, 31, 32]
  • Steroid use [33] - In 30 steroid-treated mice injected with M haemophilum, 12 developed ear lesions similar to the skin lesions observed in humans; no legions developed in mice that were not treated with steroids. [34]
  • Tattooing and eyebrow permanent makeup
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