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Disseminated Mycobacterium Haemophilum Infection Masquerading as Erythema Nodosum and Avascular Necrosis in an Immunocompromised Host

Sainato, Rebecca J., MD*; Smith, Benjamin R., MD; Parekh, Dina S., MD*; Flores, Michelle S., MD*; Logemann, Nicholas F., DO*; Chung, Ellen M., MD; Eberly, Matthew D., MD; Stagliano, David R., MD*; Malloy, Allison M.W., MD

Infectious Diseases in Clinical Practice: September 2018 - Volume 26 - Issue 5 - p e19–e21
doi: 10.1097/IPC.0000000000000568
Case Reports
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Mycobacterium haemophilum is likely an underrecognized cause of infection among patients with deficits in their cell-mediated immunity. Despite its name, which translates to “blood loving,” it remains unclear whether hyperferritinemic patients are also at higher risk of this infection. We present a 24-year-old woman with disseminated M. haemophilum infection who has hyperferritinemia and T-cell acute lymphoblastic leukemia in remission and was initially misdiagnosed as having erythema nodosum and avascular necrosis. This report highlights the clinical and histological similarities of M. haemophilum and erythema nodosum, discusses some diagnostic peculiarities, and also reviews similar cases within the literature.

Mycobacterium haemophilum is likely an underrecognized cause of infection among patients with deficits in their cell-mediated immunity. Despite its name, which translates to “blood-loving,” it remains unclear whether hyperferritinemic patients are also at higher risk of this infection. This report highlights the clinical and histologic similarities of M. haemophilum and erythema nodosum, discusses some diagnostic peculiarities, and reviews similar cases within the literature.

From the *Walter Reed National Military Medical Center, Bethesda, MD;

Tripler Army Medical Center, Honolulu, HI; and

Uniformed Services University of the Health Sciences, Bethesda, MD.

Correspondence to: Rebecca J. Sainato, MD, Department of Pediatrics, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20852. E-mail: rebecca.j.sainato.mil@mail.mil.

The authors have no funding or conflicts of interest to disclose.

Written informed consent was obtained from the patient for publication.

The views expressed in this article are those of the authors and do not reflect the official policy or position of the US Army, Department of Defense, or the US Government. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a US Government work as a work prepared by a military service member or employee of the US Government as part of that person's official duties. This work was prepared as a part of our official duties.

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