Disseminated disease caused by Mycobacterium marseillense: A case report and literature review

Abstract

Rationale: Among numerous types of nontuberculous mycobacterial infections, Mycobacterium avium complex is a related group of species, which can cause various diseases in humans. Mycobacterium marseillense is a member of the Mycobacterium avium complex, which accounts for only a small proportion of species, but causes rare diseases affecting the lungs, lymph nodes, skin, and tendon sheath. So far, very few cases have been reported.

Patient concerns: A 76-year-old male of peculiar skin infection. Metagenomic Next Generation Sequencing and bacterial culture of skin secretions revealed M marseillense. To the best of our knowledge, we report the first patient diagnosed with disseminated M marseillense infection. Here, we identified only 8 other reports of patients with M marseillense infection.

Diagnoses: Disseminated M marseillense infection.

Interventions: The patient was treated with clarithromycin, rifampicin, moxifloxacin, and ethambutol.

Outcomes: The skin lesions of the patient showed significant improvement, and his pruritus and limb pain were notably reduced after 7 months of follow-up.

Lessons: Metagenomic Next Generation Sequencing may be a useful tool to diagnose M marseillense infection, but the results should be confirmed by culture and mycobacterial identification.

Figure 1.

Changes in the appearance of the patient. (A) Infiltrated erythematous plaques and subcutaneous nodules with partial ulceration, exudation, and scabs on the nose. (B) The nasal skin lesions were significantly improved, with plaques flattening, and scabs shedding after four months of treatment. (C) Erythema and superficial scar on the nose after seven months of treatment.

Figure 2.

Chest computed tomographic (CT) scan. Showing multiple enlarged lymph nodes, interstitial changes with inflammation and small inflammatory nodules in both lungs.

Figure 3.

Positron emission tomography-computed tomography (PET-CT) scan. Showing an abnormal increase in glucose metabolism in cervical and thoracic lymph nodes, and in bones and soft tissues (bright spots). CT = computed tomographic.

Figure 4.

Histological examination. (A) HE × 100 showing mild hypertrophy and edema in the stratum spinosum of the epidermis. (B) HE × 200 showing epithelial granuloma with infiltration by a large number of lymphocytes, neutrophils, and a small number of eosinophils in the dermis.