Abstract Introduction Severe refractory asthma often requires the use of long-term immunosuppressive therapy, including oral corticosteroids (OCS) and biologics. Mycobacterium chelonae is a rapid growing non-tuberculous mycobacterium (NTM). It is a rare but recognized pathogen in immunocompromised hosts, often presenting as cutaneous or disseminated disease. Case A 76 y/o patient with a history of severe eosinophilic asthma presented for routine review. His asthma was managed with high dose inhaled corticosteroids, long-term OCS and Mepolizumab. He continued to experience exacerbations of his asthma, necessitating increase in his OCS dose for short intervals. On review, he reported the development of a severe photosensitive dermatitis, mainly affecting the upper limbs and torso. A punch biopsy was performed, demonstrating palisaded and neutrophilic granulomatous dermatosis. A short-term increased OCS course and topical emollient led to resolution of this rash, which was felt to be related to furosemide. The patient was followed up after an inpatient stay for treatment of severe exacerbation of asthma. Since discharge he had developed new cutaneous nodules on his upper limbs. He had significant exposure to a home tropical aquarium. A biopsy was performed on a sporotrichoid-pattern nodule on his right hand which confirmed granulomatous infection with Mycobacterium chelonae. A CT Thorax Abdomen and Pelvis demonstrated the presence of bilateral peribronchial wall thickening and nodularity. Sputum culture for NTM was negative. Based on susceptibility testing, the patient was commenced on IV Amikacin, Clarithromycin and Linezolid. He developed thrombocytopenia secondary to Linezolid, and Clofazimine was added empirically in its place. After two months of treatment, he had a marked improvement of his cutaneous lesions. Discussion Here we describe a case of disseminated NTM in a patient receiving immunosuppression for his asthma. The literature regarding the same is sparse. Reports suggest the prevalence of NTM pulmonary disease is increasing. This phenomenon could be explained by enhanced physician awareness of the disease. This case highlights two important points; 1) the necessity to optimize asthma management to mitigate complications associated with therapeutics; 2) to maintain high index of suspicion for atypical infections in patients receiving immunosuppression for their asthma control. This abstract is funded by: None
Kerins et al. (Fri,) studied this question.