INFECTION WITH MYCOBACTERIUM-HAEMOPHILUM IN A PATIENT WITH AIDS

History and findings: A 35-year-old HIV-infected man with a CD4 cell c ount of 100/mu l who had returned from a holiday in Spain presented wi th fever, chronic diarrhoea, cough, oral ulcers, subcutaneous nodules of about 1 cm in diameter and crusted skin ulcers of about 2 cm in dia meter at his right arm, both wrists and buttocks. Investigations: Micr oscopic examination and culture of smears of a skin ulcer revealed aci d-fast bacteria. Mycobacterial cultures of blood, sputum, urine and st ool remained sterile. Treatment and course: Before the microorganisms were identified culturally, atypical mycobacteriosis was assumed and t reatment with rifampicin, ethambutol, isoniazid and clarithromycin was started. Mycobacterium haemophilum was identified by using molecular biological techniques. Within 3 weeks the patient became afebrile and the skin ulcers healed completely. After a 7-week course, the treatmen t had to be stopped, and one month later painful subcutaneous nodules developed again at his arms and legs. A relapse of Mycobacterium haemo philum infection was confirmed by culture of a fine needle aspirate of a nodule. The same treatment was restarted and the nodules disappeare d. Conclusions: Mycobacterium haemophilum, first identified in 1978, i s an emerging pathogen in immunocompromised patients. Clinical manifes tations usually are skin ulcers, subcutaneous nodules and subcutaneous abscesses, and less frequently, systemic infection. Treatment options of this life-threatening disease have yet to be defined but therapeut ic response to tuberculostatic combination therapy has been observed. Since Mycobacterium haemophilum is a fastidious organism, special labo ratory methods are required for cultivation as well as for identificat ion.