DISSEMINATED MYCOBACTERIUM-AVIUM-INTRACEL LULARE INFECTION ASSOCIATEDWITH IMMUNOSUPPRESSIVE THERAPY OF PARANEOPLASTIC DERMATOMYOSITIS

The ubiquitous Mycobacterium avium-intracellulare (MAI) is the most fr equent cause of disseminated atypical mycobacteriosis in AIDS patients . MAI infections may develop in patients with other acquired immune de fects, such as connective tissue disorders. In adults,the gastrointest inal and respiratory systems are most frequently affected. We report a patient with dermatomyositis receiving immunosuppressive therapy in w hom only the skin and the skeletal system were affected by MAI. Becaus e it presented with polymyositis-like symptoms,the infection was initi ally not identified and treated. The MAI was cultured from a periartic ular joint effusion from the right upper arm and from venous blood, as well as identified histologically in lesional skin. Resistance to ant ibiotics developed most likely because the patient failed to take oral antibiotics regularly. Because of an acute exacerbation of the tumor- associated dermatomyositis, immunosuppressive therapy was initiated, w hile the tuberculostatic therapy was continued. Using these therapies both diseases markedly improved. In patients with connective tissue di sorders receiving longterm immunosuppressive therapy, especially when changes in symptoms and signs are observed, opportunistic infections s uch as MAI should be considered and included in the differential diagn osis.