Ecthyma gangrenosum-like lesions associated with disseminated nontuberculous mycobacterial infection in an HIV-infected patient.

Ecthyma gangrenosum typically occurs in patients who are immunocompromised. It is most often associated with a Pseudomonas aeruginosa bacteremia but other pathogens can be found. We report an HIV-infected patient with disseminated nontuberculous mycobacterial infection who presented with fever, mucous bloody diarrhea and cutaneous lesions on both legs. The cutaneous lesions had ecthyma gangrenosum feature and the histopathology was compatible with erythema induratum. Hemoculture was positive for nonchromogen slowly growing mycobacteria.

Reactive neutrophilic dermatoses associated with nontuberculous mycobacterial infection in adult-onset immunodeficiency syndrome responded well to acitretin: four cases report.

BACKGROUND: Recent articles have suggested an adult-onset immunodeficiency syndrome that was described in HIV-uninfected adults with disseminated non-tuberculous mycobacterial infection and/or another opportunistic infection with concomitant reactive dermatoses. Few studies reported the drugs used to treat these reactive neutrophilic dermatoses including systemic steroid, etretinate, clofazimine, colchicine, and dapsone. This study aims to report the efficacy of acitretin for the treatment of this condition. MATERIAL AND METHOD: Four HIV-uninfected patients with disseminated non-tuberculous mycobacterial infection and the reactive dermatoses from department of internal medicine, Maharaj Nakorn Chiang Mai Hospital between 2008 through 2011 were observed in the clinical presentation and course of disease including treatment and response. RESULTS: All patients had at least one episode of reactive dermatoses with variable presentations comprising Sweet's syndrome with pustules, pustular vasculitis-like lesions, or generalized pustular lesions. Acitretin was prescribed to treat these reactive neutrophilic dermatoses. It showed a good response without side effects. CONCLUSION: Acitretin, a second-generation retinoid, can be used for the treatment of reactive pustular lesions in the syndrome of adult-onset immunodeficiency due to its good response, being well tolerated, and without immunosuppression.