Abstract

Mycobacterium chelonae is a type of rapidly growing nontuberculous mycobacteria that causes a wide variety of infections in humans including cellulitis, abscesses, and rarely dissemination. We present a case of disseminated sporotrichoid lymphocutaneous M. chelonae in a 51-year-old immunocompromised male. This case presents a 51-year-old immunocompromised male with a past medical history of rheumatoid arthritis who presented with athralgia, cough, and four months of cellulitis and cutaneous nodules on the left lower extremity. The nodules were fluid filled and extremely painful. He also complained of a dry, non-productive cough and had bilateral confluent, diffuse, ground glass opacities of the lungs on chest CT. On exam, he was tachycardic, hypotensive, and dyspneic, and skin exam showed diffuse lesions in various stages of healing along the left lower extremity in a sporotrichoid pattern. The lesions varied in appearance with some being nodular, targetoid, necrotic, or pustulating. The left leg was warm to touch, and the lesions were extremely tender to palpation. He underwent punch biopsy of the skin lesions, thoracentesis, and bronchoscopy with bronchoalveolar lavage and was treated empirically for sepsis with broad spectrum antibiotics and steroids. The patient began to show improvement, and his cultures later came back positive for M. chelonae. This case presented a unique diagnostic challenge given the patient’s nonspecific symptoms and lymphocutaneous dissemination of a rapidly growing mycobacteria in a sporotrichoid pattern. Nontuberculous mycobacteria are steadily becoming more prevalent and warrants further consideration in the differential diagnosis of patients with simultaneous cutaneous lesions and pulmonary findings.