Tenosynovitis and Sporotrichoid Disease Due to M. marinum on a Patient under Anti-TNFα Therapy


There have been several reports of tuberculosis (TB) and, less frequently, of nontuberculous mycobacterial (NTM) infections in association with tumor necrosis factor α inhibitor (anti-TNFα) therapy. Mycobacterium marinum is a NTM with a distinct epidemiology and is infrequently responsible for disease in humans. Most commonly, it causes localized skin infections, but in 20% to 40% of cases, it involves deeper structures. Disseminated disease is exceptional and has been reported to occur only in immunocompromised patients. The authors report a clinical case of tenosynovitis and sporotrichoid disease due to M. marinum in a 45-year-old male patient under anti-TNFα therapies for spondyloarthropathy. Along antimicrobial therapy, the patient underwent surgical debridement and after two years he is still on treatment but substantially improved. A few cases of M. marinum infection occurring in patients treated with anti-TNFα drugs have been reported. The diagnosis of infection due to M. marinum requires a high index of suspicion from a properly obtained exposure history and is important so that efficient diagnostic approach and treatment are ensured.

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D. Póvoas, J. Machado and F. Maltez, "Tenosynovitis and Sporotrichoid Disease Due to M. marinum on a Patient under Anti-TNFα Therapy," Advances in Infectious Diseases, Vol. 3 No. 4, 2013, pp. 295-299. doi: 10.4236/aid.2013.34045.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] W. J. Lee, S. M. Kang, H. Sung, C. H. Won, S. E. Chang, M. W. Lee, et al., “Non-Tuberculous Mycobacterial Infections of the Skin: A Retrospective Study of 29 Cases,” Journal of Dermatology, Vol. 37, No. 11, 2010, pp. 965-972. http://dx.doi.org/10.1111/j.1346-8138.2010.00960.x
[2] J. Keane, S. Gershon, R. P. Wise, E. Mirabile-Levens, J. Kasznica, W. D. Schwieterman, et al., “Tuberculosis Assoicated with Infliximab, a Tumor Necrosis Factor AlphaNeutralizing Agent,” The New England Journal of Medicine, Vol. 345, No. 15, 2001, pp. 1098-1104.
[3] K. L. Winthrop, E. Chang, S. Yamashita, M. F. Iademarco and P. A. LoBue, “Nontuberculous Mycobacteria Infections and Anti-Tumor Necrosis Factor Alpha Therapy,” Emerging Infectious Diseases, Vol. 15, No. 10, 2009, pp. 1556-1561. http://dx.doi.org/10.3201/eid1510.090310
[4] P. Escalonilla, J. Esteban, M. L. Soriano, M. C. Fariña, E. Piqu, R. Grilli, et al., “Cutaneous Manifestations of Infection by Nontuberculous Mycobacteria,” Clinical and Experimental Dermatology, Vol. 23, No. 5, 1998, pp. 214221. http://dx.doi.org/10.1046/j.1365-2230.1998.00359.x
[5] M. L. Street, I. J. Umbert-Millet, G. D. Roberts and W. P. Su, “Non-Tuberculous Mycobacterial Infections of the Skin. Report of Fourteen Cases and Review of the Literature,” Journal of the American Academy of Dermatology, Vol. 24, No. 2, Pt 1, 1991, pp. 208-215.
[6] R. Dodiuk-Gad, P. Dyachenko, M. Ziv, A. Shani-Adir, Y. Oren, S. Mendelovici, et al., “Nontuberculous Mycobacterial Infections of the Skin: A Retrospective Study of 25 Cases,” Journal of the American Academy of Dermatology, Vol. 57, No. 3, 2007, pp. 413-420.
[7] R. Bartralot, V. García-Patos, D. Sitjas, L. RodríguezCano, J. Mollet, N. Martín-Casabona, et al., “Clinical Patterns of Cutaneous Nontuberculous Mycobacterial Infections,” British Journal of Dermatology, Vol. 152, No. 4, 2005, pp. 727-734.
[8] A. Norden and F. Linell, “A New Type of Pathogenic Mycobacterium,” Nature, Vol. 168, No. 4280, 1951, p. 826. http://dx.doi.org/10.1038/168826a0
[9] A. Aubry, O. Chosidow, E. Caumes, J. Robert and E. Cambau, “Sixty-Three Cases of Mycobacterium Marinum Infection: Clinical Features, Treatment, and Antibiotic Susceptibility of Causative Isolates,” Archives of Internal Medicine, Vol. 162, No. 15, 2002, pp. 1746-1752.
[10] S. P. Chow, F. K. Ip, J. H. Lau, R. J. Collins, K. D. Luk, Y. C. So, et al., “Mycobacterium Marinum Infection of the Hand and Wrist,” Results of Conservative Treatment in Twenty-Four Cases,” The Journal of Bone & Joint Surgery, Vol. 69, No. 8, 1987, pp. 1161-1168.
[11] L. C. Hurst, P. C. Amadio, M. A. Badalamente, J. L. Ellstein and R. J. Dattwyler, “Mycobacterium marinum Infections of the Hand,” Journal of Hand Surgery, Vol. 12, No. 3, 1987, pp. 428-435.
[12] N. Parrish, R. Luethke, K. Dionne, K. Carroll and S. Riedel, “Case of Mycobacterium Marinum Infection with Unusual Patterns of Susceptibility to Commonly Used Antibiotics,” Journal of Clinical Microbiology, Vol. 49, No. 5, 2011, pp. 2056-2058.
[13] P. Ang, N. Rattana-Apiromyakij and C. L. Goh, “Retrospective Study of Mycobacterium marinum Skin Infections,” International Journal of Dermatology, Vol. 39, No. 5, 2000, pp. 343-347.
[14] R. Dodiuk-Gad, P. Dyachenko, M. Ziv, A. Shani-Adir, Y. Oren, S. Mendelovici, et al., “Nontuberculous Mycobacterial Infections of the Skin: A Retrospective Study of 25 Cases,” Journal of the American Academy of Dermatology, Vol. 57, No. , 2007, pp. 413-420.
[15] M. H. Ho, C. K. Ho and L. Y. Chong, “Atypical Mycobacterial Cutaneous Infections in Hong Kong: 10-Year Retrospective Study,” Hong Kong Medical Journal, Vol. 12, No. 1, 2006, pp. 21-26.
[16] H. N. Pang, J. Y. Lee, M. E. Puhaindran, S. H. Tan, A. B. Tan and F. C. Yong, “Mycobacterium Marinum as a Cause of Chronic Granulomatous Tenosynovitis in the Hand,” Journal of Infection, Vol. 54, No. 6, 2007, pp. 584-588. http://dx.doi.org/10.1016/j.jinf.2006.11.014
[17] F. M. Lewis, B. J. Marsh and C. F. von Reyn, “Fish Tank Exposure and Cutaneous Infections Due to Mycobacterium Marinum: Tuberculin Skin Testing, Treatment, and Prevention,” Clinical Infectious Diseases, Vol. 37, No. 3, 2003, pp. 390-397. http://dx.doi.org/10.1086/376628
[18] D. Wagner and L. S. Young, “Nontuberculous Mycobacterial Infections: A Clinical Review,” Infection, Vol. 32, No. 5, 2004, pp. 257-270.
[19] J. P. Cheung, B. Fung, S. S. Wong and W. Y. Ip, “Review Article: Mycobacterium marinum Infection of the Hand and Wrist,” Journal of Orthopaedic Surgery (Hong Kong), Vol. 18, No. 1, 2010, pp. 98-103.
[20] J. A. Dare, S. Jahan, K. Hiatt and K. D. Torralba, “Reintroduction of Etanercept during Treatment of Cutaneous Mycobacterium Marinum Infection in a Patient with Ankylosing Spondylitis,” Arthritis & Rheumatism, Vol. 61, No. 5, 2009, pp. 583-586.

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