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Barrett G. Levesque, William J. Sandborn, Mycobacterium marinum infection in the setting of antitumor necrosis factor alpha therapy for Crohn's disease, Inflammatory Bowel Diseases, Volume 17, Issue 6, 1 June 2011, Pages 1443–1444, https://doi.org/10.1002/ibd.21512
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To the Editor:
Infection or reactivation of mycobacterium tuberculosis and atypical mycobacterium has been documented as a risk of antitumor necrosis factor alpha (anti-TNF-α) therapy.1,2 Infection with Mycobacterium marinum has been previously reported in only two individuals with Crohn's disease (CD) treated with anti-TNF-α therapy.3,4 Management of CD in this setting is unclear.
We present two cases of M. marinum infection in the setting of CD treated with anti-TNF-α biologic therapy. All patients included in this report provided authorization for medical record review for research purposes and the study was approved by the Mayo Clinic Institutional Review Board.
Case 1
A 60-year-old man with Crohn's ileocolitis had been treated with infliximab monotherapy for 6 months when he developed a red papule on the tip of his finger. The papule grew in size, and subsequently subcutaneous nodules developed on the hand and forearm. Infliximab was discontinued and several brief courses of empiric antibiotics were unsuccessful. Six months later, after repeated cultures that had not revealed a source of infection, a careful history taken by his dermatologist revealed a history of hand injury and fish tank cleaning prior to the development of his hand infection. Culture from a lesion grew M. marinum. He underwent incision and drainage of all nodules and was treated with 6 months of minocycline therapy. The skin lesions improved and no new nodules appeared. The patient was evaluated in the Inflammatory Bowel Disease Center at the Mayo Clinic (Rochester, MN) 3 months after finishing minocycline. He and his primary physician questioned treatment options for his CD and if life-long antibiotic-suppressive therapy was required during treatment with anti-TNF-α biologic therapy.
