1603. Our experience with M. marinum cutaneous infections in three patients receiving anti TNFα
Session: Poster Abstract Session: Viruses and Bacteria in Immunocompromised Patients
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • Our experience with M. marinum cutaneous infections in three patients receiving anti TNFα.pdf (386.6 kB)
  • Background:

    TNFα inhibitors are a well-known risk factor for active tuberculosis but less is known about the link between TNFα inhibitors and other mycobacterial diseases, particularly M. marinum. With the increase in use of these medications, and the trend toward more outdoors activities that include aquatic environment exposure, focus should be on better understanding of the link between use of TNFα inhibitors and the development of a severe M. marinum infection that might require earlier diagnosis and more aggressive antibiotic therapy.

    Methods:

    We will describe our experience with three cases of aggressive cutaneous M. marinum infection in patients taking anti-TNFα that presented to Abington Memorial Hospital in Pennsylvania between 2014 and 2017

    Results:

    Age, gender, diagnosis

    Anti TNFα, duration and indication

    Exposure

    Delay in diagnosis

    Treatment

    Progression

    47 y.o F

    Cellulitis/lymphangitis

    Etanercept, 5 years, for RA

    Municipal pool

    2 weeks

    Clarithromycin+ etmabutol

    Cleared in 2 months

    34 y.o M

    cellulitis

    Infliximab, 7 years, UC

    Salt water fish tank

    10 weeks

    Clarithromycin+ etmabutol

    Cleared in 3 weeks

    62 y.o F

    Cellulitis/lymphangitis

    Adalimumab, 8 months, RA

    Barnacle injury

    4 weeks

    Clarithromycin+ Rifampin

    Cleared in 1 month

    Conclusion:

    TNFα is not only linked to active TB, but also associated with other mycobacterial diseases including M. marinum. While CDC reports a delay of 17 months from time of onset of symptoms to establishing the diagnosis, our 3 cases were diagnosed much earlier. Early diagnosis relies probably on involvement of Infectious diseases specialists early in the course of the illness and the readiness in sampling of the lesions. The challenge to the clinicians remain in the safety and the timing of resuming anti TNFα treatment after M. marinum infection.

    Nabil Zeineddine, MD, Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, Melissa Tiyouh, MD, Drexel University College of Medicine, Philadelphia, PA and Todd Braun, MD, Infectious Disease, Abington Memorial Hospital, Abington, PA

    Disclosures:

    N. Zeineddine, None

    M. Tiyouh, None

    T. Braun, None

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