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February 2002

Broad Spectrum of Dermatologic Manifestations Caused by Mycobacterium haemophilum Infection

Author Affiliations

From the Department of Medicine, Divisions of Allergy and Infectious Diseases (Drs Geisler, Harrington, and Liles) and Dermatology (Dr Harnisch), and Harborview Medical Center Microbiology Laboratory and the Department of Laboratory Medicine (Dr Wallis), University of Washington, Seattle.

Arch Dermatol. 2002;138(2):229-230. doi:10.1001/archderm.138.2.229

Mycobacterium haemophilum typically infects superficial tissues in immunocompromised persons and can lead to systemic illness. Its natural habitat is unknown, although most cases have been reported from cities near large bodies of water.1 No cases have been previously reported from the northwestern area of the United States. We report 2 cases of M haemophilum infection that demonstrate the broad spectrum of dermatologic manifestations in varied clinical settings; both cases occurred in the state of Washington.

A 59-year-old man with diabetes presented with purulent superficial ulceration involving the scrotum and inguinal folds (Figure 1) that had progressed from a scrotal pustule over a 1-year period. Topical antifungal agents and corticosteroids were ineffective. Biopsy specimens were obtained from the edges of the ulcer. Smears were negative for acid-fast bacilli. Three weeks later, cultures yielded M haemophilum, a finding that was confirmed by gas-liquid and high-performance liquid chromatography. The organism was susceptible to amikacin, ciprofloxacin, clarithromycin, doxycycline, and rifampin. Treatment with ciprofloxacin, rifabutin, and clarithromycin led to clinical improvement during the ensuing months.