Our patient had skin M

Our patient had skin M intracellulare infections involving different skin areas within a short period. In view of the simultaneous occurrence of multiple lesions and the absence of related local skin trauma histories, we suspected that his skin infections might result from a hematogenous or lymphatic spreading. The atypical pneumonia one year before the skin eruptions might be the source of his primary infection, which was partially controlled by the antibiotics. In a study conducted by Reed and colleagues, the most significant environmental risk factor for MAC infections was cumulative occupational exposure to soil. The cumulative exposure to recycled wastes, the prior pulmonary tuberculosis, and the history of decades of smoking might contribute to the vulnerability to MAC pulmonary infection in our patient. The pathogenesis of disseminated MAC infections in patients without recognizable underlying immunosuppression is not well known. Congenital or acquired defects in the interferon (IFN)-γ/ interleukin (IL)-12 pathways had been observed in some of these patients. Although in most literature, M avium and M intracellulare were not differentiated due to their similar biochemical characteristics, some epidemiologic studies implicated that these two organisms exhibited different virulence. Most of the MAC infections in AIDS patients were caused by M avium, whereas M intracellulare was responsible for a larger portion of MAC lung diseases in non-HIV patients. Moreover, among non-AIDS patients with MAC isolated, only 16.2% of the patients with M avium had an American Thoracic Society-defined probable to definite infection, which is in eletriptan with 63.1% of the M intracellulare group. An ecologic study revealed that M intracellulare tended to form biofilm more often than M avium. This attachment and growth ability might provide an explanation for the higher pathogenic property of M intracellulare. Currently, an established principle for treatment of MAC infections is a macrolide based two- or three-drug regimen for 6–12 months. In our case, because of the clinical resolution, the patient refused further treatment after 4 months of clarithromycin and levofloxacin. No relapse was observed after a 2-year follow-up. As the current MAC treatment guideline is mainly based on pulmonary infection, whether a shorter course is acceptable for isolated multiple cutaneous MAC infection remains unknown due to the rarity of such cases. The prognosis varies widely and may be affected by the underlying diseases, affected sites, and early treatment. We report a rare presentation of disseminated M intracellulare infection. It is interesting to note that most cases of disseminated cutaneous MAC infection in immunocompetent hosts are reported from Japan. However, it remains unknown whether this is due to a report bias or there is a true racial or geographic difference. The diagnosis of nonulcerated MAC infection without an identifiable concurrent primary focus remains challenging and a correct diagnosis is often delayed. More clinical vigilance is required for such cases.
Introduction Lymphadenopathies in patients with pemphigus vulgaris (PV) have been attributed to several causes, including infections, malignant melanoma, Castleman\'s disease, or lymphoma. Reactive lymphadenopathy in association with pemphigus such as dermatopathic lymphadenitis (DL) has rarely been reported, with only one case found in the literature. DL is a histopathologic diagnosis of reactive lymph node hyperplasia, which is characterized by increased numbers of interdigitating reticulum cells, Langerhans cells, and histiocytes with lipid and melanin deposits. The lymph nodes are usually moderately enlarged and not tender. DL is typically associated with exfoliative or eczematoid inflammatory erythrodermas. Importantly, the early lymph node involvement of mycosis fungoides or Sézary syndrome (MF/SS) may be difficult to differentiate from the features of DL. Awareness of DL and its potential relationship with MF/SS may be crucial to improving prognosis.