Hautinfektion durch Mycobacterium gordonae bei einem immunkompetenten Patienten

Mycobacterium gordonae is a potentially pathogenic environmental mycobacterium occasionally causing skin infections in immunocompromised patients but only rarely affecting healthy patients. Methods: A 41-year-old engine driver of goods trains presented with a 2 year existing 7 x 7 cm, scaly erythematous and infiltrating skin lesion on his left shin which clinically resembled microbial eczema, granuloma anulare or necrobiosis lipoidica. Objectives: Histologic examination revealed a psoriasis-like, lichenoid plasmacellular infiltrate and spongiotic interface dermatitis. Ziehl-Neelsen staining and PAS reaction as well as alcian blue staining to detect mucin were negative. In microbiological culture M. gordonae was detected. Conclusion: The tumour was too extended to be excised. Therefore a combined therapy of doxycycline and trimethoprim /sulfamethoxazol was started, however, without any effect. Under clarithromycine (500 mg/d) and moxifloxacine [400 mg/d) the skin lesions showed regression after two months. Therefore an additional tuberculostatic therapy with rifampicin or isoniacid was not considered necessary.