Nichttuberkulöse Mykobakteriose als seltene Ursache chronischer Wunden

Wir berichten über einen 77-jährigen Patienten mit seit 8 Monaten progredienten Wunden am rechten Unterschenkel. Die histopathologische Untersuchung zeigte eine teils suppurative und teils granulomatöse Entzündung mit Nachweis von Mykobakterien, welche mit dem Nachweis von Mycobakterium chelonae/immunogenum mittels Nukleinsäureamplifikationstechnik im Referenzlabor als nichttuberkulöse Mykobakteriose (NTM) bestätigt wurde.

Abstract

We report on a 77-year-old patient with wounds on the right lower leg that had been progressive for eight months. The histopathological examination showed a partly suppurative and partly granulomatous inflammation with evidence of mycobacteria, which was confirmed as nontuberculous mycobacteriosis (NTM) by the detection of Mycobacterium chelonae/immunogenum using the nucleic acid amplification technique in the reference laboratory. The initiation of combined antibiotic therapy clarithromycin 500mg 1–0-1–0 p.o. and moxifloxacin 400mg 1–0-0–0 p.o. over 12 months led to a rapid response to therapy and ultimately to complete healing. This case underlines the relevance of considering NTM and other infections as a rare differential diagnosis in patients with chronic wounds. In addition to the presence of immunosuppression, unilateral and/or sporotrichoid distribution may be additional clues. As the detection of non-tuberculous mycobacteria is not always directly successful, repeated diagnostics and close collaboration with histopathology and microbiology laboratories is often necessary.

Schlüsselwörter

kutane nicht-tuberkulöse Mykobakteriose - Mykobakterium chelonae - Chronische Wunden

Keywords

cutaneous nontuberculous mycobacterial infection - mycobacterium chelonae - chronic wounds

Publikationsverlauf

Eingereicht: 24. Februar 2025

Angenommen nach Revision: 14. April 2025

Artikel online veröffentlicht:
04. Juni 2025

• Literatur

• 1 Schoenfeld N, Haas W, Richter E. et al. Recommendations of the German Central Committee against Tuberculosis (DZK) and the German Respiratory Society (DGP) for the Diagnosis and Treatment of Non-tuberculous Mycobacterioses. Pneumologie 2016;
• 2 Daley CL, Iaccarino JM, Lange C. et al. Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline. Eur Respir J 2020;
• 3 Gonzalez-Santiago TM, Drage LA. Nontuberculous Mycobacteria: Skin and Soft Tissue Infections. Dermatol Clin 2015;
• 4 Gill CO, Saucier L, Meadus WJ. Mycobacterium avium subsp. paratuberculosis in dairy products, meat, and drinking water. J Food Prot 2011;
• 5 Lee WJ, Kang SM, Sung H. et al. Non-tuberculous mycobacterial infections of the skin: a retrospective study of 29 cases. J Dermatol 2010;
• 6 Bös L, Schönfeld N, Schaberg T. Nichttuberkulöse Mykobakterien – eine kurze Übersicht zur Epidemiologie, Diagnostik und Therapie. Pneumologie 2015;
• 7 Sepulcri C, Vena A, Bassetti M. Skin and soft tissue infections due to rapidly growing mycobacteria. Curr Opin Infect Dis 2023;
• 8 Tokunaga DS, Siu AM, Lim SY. Nontuberculous mycobacterial skin and soft tissue infection in Hawai’i. BMC Infect Dis 2022;
• 9 Nogueira LB, Garcia CN, Costa MSCD. et al. Non-tuberculous cutaneous mycobacterioses. An Bras Dermatol 2021;
• 10 Jones RS, Shier KL, Master RN. et al. Current significance of the Mycobacterium chelonae-abscessus group. Diagn Microbiol Infect Dis 2019;