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Case Reports in Dermatological Medicine
Volume 2013 (2013), Article ID 793127, 3 pages
http://dx.doi.org/10.1155/2013/793127
Case Report

Mycobacterium haemophilum Masquerading as Leprosy in a Renal Transplant Patient

1Department of Medicine, Tripler Army Medical Center, Honolulu, HI 96859, USA
2Dermatology Service, Tripler Army Medical Center, Honolulu, HI 96859, USA
3Infectious Disease Service, Tripler Army Medical Center, Honolulu, HI 96859, USA

Received 31 August 2013; Accepted 25 September 2013

Academic Editors: I. D. Bassukas, K. Jimbow, M. Jinnin, and J. A. Tschen

Copyright © 2013 Nathanial K. Copeland et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Opportunistic infections following immunosuppression in solid organ transplant (SOT) patients are common complications with the skin being a common sight of infection. Nontuberculous mycobacteria (NTM) are rare but potential causes of skin infection in SOT patients. We present a case of an adult male immunosuppressed following renal transplantation who presented with an asymptomatic rash for several months. The patient’s skin eruption consisted of erythematous papules and plaques coalescing into an annular formation. After failure of the initial empiric therapy, a punch biopsy was performed that demonstrated nerve involvement suspicious for Mycobacterium leprae. However, culture of the biopsy specimen grew acid-fast bacilli that were subsequently identified as M. haemophilum. His rash improved after a prolonged course of clarithromycin and ciprofloxacin. Both organisms are potential causes of opportunistic skin infections and can be difficult to distinguish with similar predilection for skin and other biochemical and genetic similarities. Ultimately they can be distinguished with culture as M. haemophilum will grow in culture and M. leprae will not. This case was unique due to nerve involvement on biopsy which is classically seen on biopsies of leprosy.