Cutaneous Mycobacterium massiliense infection at the site of prior herpes zoster infection in an immunosuppressed patient after long-term use of steroid = Cutaneous Mycobacterium massiliense infection at the site of prior herpes zoster infection in an immunosuppressed patient after long-term use of steroid

다국어 초록 (Multilingual Abstract)

The incidence of cutaneous non-tuberculous mycobacterium (NTM) infection is growing as the number of invasive procedures on the skin and the use of immunosuppressants increase. We report a 45-year-old female with a history of vasculitis presenting zosteriform ulcers with violaceous borders and erythematous nodules on the left upper arm of 2 weeks’ duration without a history of trauma. Three months earlier she had herpes zoster infection in the identical area, and after the resolution of zoster lesions, firm subcutaneous nodules with dusky erythematous overlying surface developed in the same sites. Ten days after the eruption of herpes zoster, she complained of arthritis, neuropathy and tender nodules with dusky erythematous patches on the left lower leg. For suspected vasculitis, she received a high dose of steroid for 3 months at another hospital. Skin biopsy from a left arm nodule demonstrated septolobular panniculitis with marked neutrophilic infiltration in the subcutis and deep dermis. Ziehl-Neelsen stain and polymerase chain reaction (PCR) for NTM from both the tissue biopsied and a swab from the ulcers produced positive findings. Mycobacterium massiliense was identified by culture. One week after her initial visit, she was admitted due to dyspnea, sputum and fever. All the symptom was from Pneumocystis carinii pneumonia, which eventually led her to death. The importance of judicious use of steroid can’t be overemphasized.