MYCOBACTERIUM HAEMOPHILUM AND CRYPTOCOCCUS NEOFORMANS COINFECTION IN A SYSTEMIC LUPUS ERYTHEMATOSUS PATIENT

Mycobacterium haemophilum and Cryptococcus neoformans are human pathogens in immunocompromised individuals. They exhibit a diversity of cutaneous manifestations and could cause disseminated infections. Herein, we report a Thai female with an underlying disease of systemic lupus erythematous, end stage renal disease and hypertension who was on immunosuppressive therapy and diagnosed with disseminated M. haemophilum and C. neoformans coinfection. She presented with multiple indurated plaques on her back, oedematous plaques on both legs and feet with nodules and ulcers on her right leg. She was diagnosed by skin biopsy, acid-fast staining, real-time polymerase chain reaction, tissue culture and haemoculture. A combination of rifampicin, macrolide, fluoroquinolone, amikacin and co-trimoxazole were used to cure M. haemophilum infection. Cryptococcosis was treated with amphotericin B and flucytosine for 5 weeks, then followed by fluconazole. We aim to report a unique dermatological manifestation, microbiology, histopathology, and treatment of the disease. Successful diagnosis and multiple antimicrobials agents are key managements for Mycobacterium haemophilum infection and Cryptococcosis.