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Joint Bone Spine
Volume 74, n° 4
pages 385-388 (juillet 2007)
Doi : 10.1016/j.jbspin.2006.11.015
Received : 1 September 2006 ;  accepted : 6 November 2006
Skin and joint infection by Mycobacterium chelonae : Rescue treatment with interferon gamma
 

Sandrine Jousse-Joulin a, Michel Garre b, Xavier Guennoc a, Claire Destombe a, Isabelle Samjee a, Valérie Devauchelle-Pensec a, Alain Saraux a,
a Rheumatology Department, Brest Teaching Hospital, Brest, France 
b Internal Medicine and Infectious Diseases Department, Brest Teaching Hospital, Brest, France 

Corresponding author. Service de Rhumatologie, CHU de Brest, Hopital de la Cavale Blanche, BP 814, 29609 Brest Cedex, France. Tel.: +33 298 347 267; fax: +33 298 493 627.
Abstract
Introduction

Atypical mycobacteria are environmental organisms that cause opportunistic infections in humans.

Case report

A 50-year-old electronics engineer sought advice about starting TNFα antagonist therapy for ankylosing spondylitis. Disease duration was 23years and current treatment was methylprednisolone 4mg/d. Atypical skin lesions and knee arthritis were noted. Fluid aspirated from the knee showed inflammatory properties and a few acid-fast bacteria, which a line probe assay identified as Mycobacterium chelonae . The same organism was found in a skin biopsy from a thigh lesion. Antimicrobial treatment was started immediately. Inadequate results 6months later prompted synovectomy of the knee followed by interferon gamma, 50μg/m2 body surface area subcutaneously 3 times a week. After 16months, there were no new skin or joint lesions, and the antimicrobials and interferon gamma were therefore discontinued.

Conclusion

This highly unusual case suggests that interferon gamma may be effective in patients with M. chelonae infection that fails to respond adequately to antimicrobials.

The full text of this article is available in PDF format.

Keywords : Mycobacterium chelonae , Ankylosing spondylitis, Septic arthritis, Interferon gamma




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