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Case Report
 
Chronic cutaneous lesions in immunocompromised patients
Wei-Chieh Lee1, Wei-Sin Li2, Chih-Hsiung Lee3
1MD, Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
2MD, Division of Infection, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
3MD, Division of General Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.

doi:10.5348/ijcri-201517-CR-10478

Address correspondence to:
Chih-Hsiung Lee
MD 123, Ta Pei Road
Niao Sung District, Kaohsiung City, 83301
Taiwan
Republic of China

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How to cite this article
Lee Wei-Chieh, Li Wei-Sin, Lee Chih-Hsiung. Chronic cutaneous lesions in immunocompromised patients. Int J Case Rep Images 2015;6(2):90–94.


Abstract
Introduction: Chronic cutaneous lesions are common in immunocompromised patients and are attributable to a wide range of potential microbial pathogens. Common infections may have a variety of unusual manifestations, and unusual pathogens can also play an important role in these infections. Therefore, "how to approach" these lesions becomes a difficult problem.
Case Report: A 42-year-old male had medical history of immune thrombocytopenic purpura (ITP), chronic hepatitis C with liver cirrhosis, Child's-Pugh-Turcotte score A, and end stage renal disease requiring maintenance hemodialysis. The patient also suffered from multiple ecchymoses and tender plaques on all four limbs for one month. A pathology of skin biopsy showed lobular panniculitis and a strong positive finding of acid-fast bacilli (AFB). A bone marrow biopsy also showed a strong positive finding of AFB but no granulomatous inflammation. The patient was treated as disseminated tuberculosis infection and experienced anti-tuberculosis (TB) drug-related adverse effects. Finally, non-tuberculous mycobacteria (NTM) was diagnosed. There are difficulties regarding how to survey and treat immunocompromised patients due to multiple side effects and comorbidities. In recent years, NTM has been characterized as an emerging pathogen.
Conclusion: Cutaneous lesions in immunocompromised patients are complex because of a wide range of potential microbial pathogens. Common infections may have unusual manifestations in immunocompromised patients. The NTM is an emerging opportunistic pathogen in severely immunocompromised patients with acquired immunodeficiency syndrome or a transplantation in recent years. The incidence of pulmonary or extrapulmonary NTM infection has increased dramatically in recent years. We should consider NTM infection if a clinical condition does not improve after several months of anti-TB therapy.

Keywords: Chronic Cutaneous Lesion, End stage renal disease, Immune thrombocytopenic purpura, Nontuberculous mycobacteria


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Author Contributions
Wei-Chieh Lee – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Wei-Sin Li – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Chih-Hsiung Lee – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Wei-Chieh Lee et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



About The Authors

Wei-Chieh Lee is Attending Doctor at division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. He has published three research papers in national and international academic journals. His research interests include general cardiology, interventional cardiology and electrophysiology study. He intends to pursue PhD's in future.



Wei-Sin Li is Resident at Division of Infection, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. He has published only one research papers in reputed academic journals. His research interests include infection, microbiology and epidemiological.



Chih-Hsiung Lee is Chief at Division of General Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. He has published several research papers in national and international academic journals. His major research interests include general nephrology, peritoneal dialysis and hemodialysis.