Mycobacterium chelonae Infection and TNFα Blockade

Abstract: The atypical mycobacterium Mycobacterium chelonae grows rapidly and is a normal commensal organism in water and soil. As a ubiquitous, facultative organism, Mycobacterium chelonae infections are frequently associated with trauma, indwelling catheters, surgery, chronic debilitating illness, or immunosuppressive agents. Tumor necrosis factor (TNF) α has a key role in immune reactions to intracellular pathogens. TNFα antagonists have been used increasingly to manage inflammatory diseases as rheumatoid arthritis. Very few cutaneous infections involving Mycobacterium chelonae associated with an anti-TNFα blockade have been reported. Despite rare cases, almost all reports underline the difficulties of effectively treating this infection; using clarithromycin and another antibiotic, like levofloxacin to avoid the development of resistant bacteria, lead to a favorable outcome. Through my experience on Mycobacterium chelonae cutaneous infection in a patient with rheumatoid arthritis who was undergoing etanercept treatment, a literature review of the Mycobacterium chelonae infection association with TNFα blockade is included.

Keywords: tumor necrosis factor α, rheumatoid arthritis, Mycobacterium chelonea