Mycobacterium intracellulare Infection Mimicking Progression of Scleroderma. Case Reports in Rheumatology
Volume 2017, Article ID 4029271, 3 pages.
Danish case report of a woman in her 40s with seropositive scleroderma (SD), exhibiting a positive ANA with nuclear speckled pattern, rheumatoid factor, and high titer anti-SSA antibodies. In addition, she had clearly identifiable disease features, including sclerodactyly, Raynaud’s phenomenon, abnormal nail fold capillary test, interstitial lung disease, esophageal dysmotility, and severe inflammatory skin and muscle fasciae changes. Failing several immunosuppressive treatments, it was found that her progressively worsening symptoms were being caused by the infection Mycobacterium intracellulare (M. intracellulare) in spite of normal immunoglobulin levels. This infection was discovered after she had received high-dose prednisolone that led to hospitalization for Listeria monocytogenes meningitis. After successful recovery from the meningitis, she was then administered a 12-month course of clarithromycin and rifampin combination oral antibiotic therapy for the M. intracellulare infection. This combination antibiotic protocol resulted in substantially significant improvements in her skin, arthritis, and fatigue, and her leg wounds also healed. These authors conclude that M. intracellulare was the cause of a severely-progressive case of SD and that this infection should be considered as a differential cause of disease in cases that are unresponsive to immunosuppressive therapies.