CHRONIC CUTANEOUS LESIONS IN A PATIENT WITH SEVERE HIV-RELATED IMMUNOSUPPRESSION: THE IMPORTANCE OF CULTURE FOR NON-TUBERCULOUS MYCOBACTERIA

To report a case of disseminated cutaneous mycobacteriosis caused by Mycobacterium haemophilum in a patient living with AIDS. This article summarizes information generated from two strategies: (i) a case report of a patient hospitalized at our institution; and (ii) an extensive literature review of all publications indexed in PubMed and SciELO. A 35-year-old male patient from São Paulo sought medical care for skin lesions evolving over approximately six months. The lesions were disseminated, involving the abdomen, lower limbs, and arms, beginning as macules and progressing to nodules with subsequent fistulization. Biopsy revealed chronic suppurative folliculitis, and multiple antibiotic courses were administered without resolution. Three months later, he attended an infectious diseases clinic due to persistent lesions and a positive HIV screening test. Laboratory tests showed viral load of 23,100 copies and CD4 count of 46 cells/mm³. Urinary TB-LAM rapid test was positive, and cranial, thoracic, and abdominal CT scans showed no significant abnormalities. A new biopsy with culture was requested. Based on the positive TB-LAM and clinical presentation, empirical TB treatment was initiated while awaiting culture results. After two months of RHZE therapy, tissue culture revealed Mycobacterium haemophilum . Treatment was adjusted to include clarithromycin, levofloxacin, and ethambutol, associated with TB maintenance regimen (RI). Most reported Mycobacterium haemophilum infections occur in people living with HIV and present as chronic cutaneous ulcers, skin and soft tissue infections, osteomyelitis, and septic arthritis; bacteremia, pneumonia, and meningitis are less common. Coinfection incidence between TB and NTM may vary in endemic regions from 1.2 to 2.2 per 100,000 individuals, representing 2.8% of confirmed TB cases. In a South African study, 21 of 23 patients with NTM and HIV had positive TB-LAM. M. haemophilum is intrinsically resistant to pyrazinamide but highly sensitive to macrolides and rifamycins.