Mycobacterium chelonae Cutaneous Infection: A Challenge for an Internist

Cutaneous infections caused by the Mycobacterium chelonae complex show a heterogeneous clinical presentation, which varies according to the patient’s immune status. Most standard antimycobacterials have no effect against these species. Clarithromycin alone was shown to provide adequate treatment, although resistance has been reported. Consequently, the literature supports multi-drug therapy to combat resistant strains. Here, we describe the case of a 59-year-old man under systemic immunosuppressive therapy who developed cutaneous lesions whose evolution was highly suggestive of atypical infection. LEARNING POINTS: Mycobacterium chelonae is a ubiquitous species of mycobacteria found in the environment; cutaneous infections by the M. chelonae complex show a heterogeneous clinical presentation. The combination of linezolid and clarithromycin has been used in some cases, with rapid clinical resolution and less or no relapse observed after long-term follow-up. Internal Medicine is the appropriate speciality to treat particularly complex or multisystem diseases, such as infections in immunocompromised patients.