We describe familial cases of cutaneous infection caused by Mycobacterium avium A 45-year-old father, his 14-year-old son and 11-year-old daughter, among five persons in a family, presented with a 2-month history of inflammatory subcutaneous nodules and ulcerations Histology of skin biopsy specimens showed granulomatous inflammation, and mycobacterial colonies isolated from the skin of each patient were identified as M avium by DNA hybridization analysis The patients were all treated successfully with combined drug therapy consisting of rifampicin, isoniazid and clarithromycin Their lesions were purely cutaneous M avium infection, without any visceral involvement Neither systemic disease nor immunological impairment was detected in the family However, they all used a circulating, constantly heated bath water system The bath water was continuously heated to about 40 degrees C without changing the water for a few months, and M avium was isolated from the filter of the bath tub heating unit It is considered that this unusual familial cluster of cutaneous M avium infection in healthy persons may have resulted from the use of contaminated bath water

Familial cluster of cutaneous Mycobacterium avium infection resulting from use of a circulating, constantly heated bath water system

Cutaneous infections associated with HIV/AIDS.

Infectious diseases of the skin

Cutaneous infections with Mycobacterium avium intracellulare (MAI) are uncommon in healthy patients but may arise in those with underlying immunocompromise, including patients with HIV. Their clinical manifestations are protean. We report an AIDS patient with a cutaneous MAI infection that clinically and histopathologically mimicked histoid leprosy, a presentation not previously described in this population.

Cutaneous Mycobacterium avium intracellulare infection in an HIV+ patient mimicking histoid leprosy.

23 – Bacterial and rickettsial infections

Severe disseminated infection due to Mycobacterium avium intracellulare, with unusual cutaneous features, is reported in a patient with acquired immunodeficiency syndrome (AIDS). The eruption appeared as disseminated pustular lesions which showed necrotic features and which led to varioliform scarring. Bacterial culture from the skin, blood, and bone marrow, and ultimately from the bronchoalveolar fluid and sputum, was positive for M. avium intracellulare. The patient was successfully treated using a multiple agent anti-mycobacterial regimen including clarithromycin, which appeared to be the most effective drug. This resulted in resolution of the cutaneous and general symptoms. Our patient illustrates the wide spectrum of skin presentations that may be seen with mycobacterial infections in subjects infected with the human immunodeficiency virus (HIV). Clarithromycin is an important agent for the treatment of these severe infections.

M. Rouveau

Papers

Disseminated varioliform pustular eruption due to Mycobacterium avium intracellulare in an HIV-infected patient.