RESUMEN
Infections of the soft tissues due to atypical mycobacteria are relatively uncommon. We describe two cases. A 61-year-old woman with rheumatoid arthritis (RA) who was treated with the combination of the TNF inhibitor etanercept (Enbrel) and leflunomide (Arava), developed paronychia and cellulitis of the index finger due to Mycobacterium chelonae/abscessus complex. The patient was successfully treated with clarithromycin and surgical debridement. A second case describes a 50-year-old man with ankylosing spondylitis, receiving infliximab (Remicade) and low dose corticosteroids, who developed a granulomatous infection of the right thumb and forearm due to Mycobacterium marinum.The patient was successfully treated with clarithromycin and ethambutol. The increased risk for subcutaneous mycobacterial infections in these cases are probably related to the DMARD treatment with a TNF-inhibitor and leflunomide.
Asunto(s)
Corticoesteroides , Antirreumáticos , Claritromicina , Etambutol , Isoxazoles/administración & dosificación , Infecciones por Mycobacterium no Tuberculosas , Mycobacterium chelonae , Mycobacterium marinum , Factores de Necrosis Tumoral , Corticoesteroides/administración & dosificación , Corticoesteroides/efectos adversos , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Antirreumáticos/administración & dosificación , Antirreumáticos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Claritromicina/administración & dosificación , Claritromicina/efectos adversos , Etambutol/administración & dosificación , Etambutol/efectos adversos , Femenino , Humanos , Isoxazoles/efectos adversos , Leflunamida , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Infecciones por Mycobacterium no Tuberculosas/etiología , Infecciones por Mycobacterium no Tuberculosas/microbiología , Infecciones por Mycobacterium no Tuberculosas/patología , Infecciones por Mycobacterium no Tuberculosas/fisiopatología , Mycobacterium chelonae/efectos de los fármacos , Mycobacterium chelonae/aislamiento & purificación , Mycobacterium marinum/efectos de los fármacos , Mycobacterium marinum/aislamiento & purificación , Factores de Riesgo , Piel/patología , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Infecciones de los Tejidos Blandos/etiología , Infecciones de los Tejidos Blandos/microbiología , Infecciones de los Tejidos Blandos/patología , Infecciones de los Tejidos Blandos/fisiopatología , Espondilitis Anquilosante/tratamiento farmacológico , Inhibidores del Factor de Necrosis TumoralRESUMEN
We report on one patient with Wegener's granulomatosis (WG) and two patients with microscopic polyangiitis (MPA). The patient with WG had signs of a respiratory infection and showed a c-ANCA pattern with proteinase 3 (PR3) specificity. The patients with MPA presented with pulmonary haemorrhage and signs of renal damage and showed a p-ANCA pattern with myeloperoxidase (MPO) specificity. In the three patients histopathological findings confirmed the diagnosis. We discuss the clinical indications of ANCA testing and the current terminology for reporting ANCA results (c-ANCA, p-ANCA, c-ANCA (atypical) and atypical ANCA). The target antigens and diseases associated with these different patterns are considered. Finally we focus on the value of ANCA and more specific PR3-ANCA and MPO-ANCA in the diagnosis of WG and MPA. The new application domain of ANCA in Crohn's disease and ulcerative colitis is also discussed.
