SHM Converge Scientific Abstract ePoster Gallery-A Rare Dermatological Finding in a Kidney Transplant Patient

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This case describes a 63-year-old man with a prior living-related kidney transplant who developed a rare disseminated <strong>Mycobacterium haemophilum</strong> infection while on chronic immunosuppression (mycophenolate mofetil, prednisone, and everolimus). He initially presented with dyspnea, joint pain, and painful erythematous nodules and indurated plaques on the lower extremities. Skin biopsy showed neutrophilic inflammation with necrosis, and acid-fast bacilli staining revealed numerous organisms. Because the organism is difficult and slow to grow in culture, tissue was also sent for <strong>16S rRNA PCR</strong>.

During the initial hospitalization, he was also found to have RSV infection and was discharged with ribavirin and a prednisone taper while awaiting mycobacterial speciation. Three weeks later, he was readmitted with worsening disease, including spread of nodules to the back, chest, and face, along with bilateral ground-glass opacities on CT. PCR identified <strong>M. haemophilum</strong>, and bone marrow biopsy also showed acid-fast organisms, confirming disseminated infection. He was started on prolonged multidrug therapy with <strong>azithromycin, rifabutin, and ciprofloxacin</strong> for one year.

Nine weeks after the initial presentation, he developed persistent leukocytosis and worsening lung findings. Bilateral thoracenteses demonstrated <strong>M. haemophilum</strong> on smear, leading to a diagnosis of bilateral pleural effusions due to disseminated infection. He remained on the same antibiotic regimen and was followed by pulmonology for serial thoracenteses, with improvement over time.

The report emphasizes that transplant recipients are highly vulnerable to unusual infections and that skin lesions in these patients require a broad differential diagnosis. It also highlights the importance of thorough infectious workup and the value of <strong>16S rRNA PCR</strong> for rapid identification of fastidious nontuberculous mycobacteria when cultures are delayed or negative.

Asset Subtitle

Xin Ran (Cindy) Li

Meta Tag

Author List Amber Bo, Devesh Kumar, Jenna Le, Mohan S. Dhariwal DO. PhD. FACP, Pinky Jha, Xin Ran (Cindy) Li

Category Clinical Vignettes

Concept Nontuberculous Mycobacterial Infection

Concept Cutaneous Mycobacterial Infection

Concept Mycobacterium haemophilum

Concept Skin Lesion

Concept Soft Tissue Lesion

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Xin Ran (Cindy) Li

Track Adult

Keywords

Mycobacterium haemophilum

disseminated infection

kidney transplant

immunosuppression

skin lesions

16S rRNA PCR

nontuberculous mycobacteria

pleural effusion

acid-fast bacilli

multidrug therapy

Nontuberculous Mycobacterial Infection

Cutaneous Mycobacterial Infection

Mycobacterium haemophilum

Skin Lesion

Soft Tissue Lesion