Skin nontuberculous mycobacterial infection in systemic lupus erythematosus: an unusual skin infection mimicking lupus vasculitis

Abstract

Objectives: To report 2 cases of skin nontuberculous mycobacteria (NTM) occurring in lupus patients and to systematically review the medical literature addressing skin NTM in lupus.

Methods: We reported 2 cases of skin NTM in lupus patients followed at the Toronto Lupus Clinic. We conducted a systematic review of the literature on NTM in lupus patients. Ovid Medline (1946 to March 12, 2012) and Embase (1980 to March 12, 2012) were searched for relevant publications.

Results: Of the 1356 retrieved abstracts, 19 publications were identified and 25 cases of skin NTM were extracted. Skin presentations in this review ranged from papules, plaques, and nodules to ulcerative lesions and abscesses. Skin lesions occurred in the setting of active and inactive lupus and while patients were maintained on steroids and sometimes immunosuppressants. The pathogen species included Mycobacterium chelonae, Mycobacterium haemophilum, Mycobacterium kansasii, Mycobacterium avium, Mycobacterium scrofulaceum, Mycobacterium fortuitum, Mycobacterium marinatum, and Mycobacterium szulgai. The duration of antimycobacterial drugs ranged from 3 to 12 months. Skin excision, drainage, and debridement might be required in some cases. Empirical monotherapy was used initially, and the final choice of antibiotics was based on the susceptibility determined in culture. Overall, the outcomes of the skin lesions resulted in either complete recovery or improvement.

Conclusions: A high index of suspicion in lupus patients is required to diagnose NTM, as the initial presentation of NTM can mimic lupus skin manifestations.