Uronema Marinum

[rkpetersen]

As nasty as it looks it doesnt hurt one bit.

From a medical standpoint, 'not hurting' isn't necessarily a good thing.
Pain is important, and when something looks like it should be painful but isn't, it suggests that nerve endings are being desensitized or destroyed.
For example, one of the hallmarks of leprosy, another mycobacterial disease, is chronic nerve damage and loss of sensation in the extremities.

 

[rkpetersen]

I did indeed have M. marinum. I got it from work. I got bite by an eel and it wasn't too bad and seemed to heal up and then a couple weeks later it caused a lump. HEre is the thread https://www.reef2reef.com/threads/eel-bites.388629/ Long story short is that you NEED to go see an Infectious Disease doctor. Straight up regular doctors aren't good at diagnosing rare diseases, the biopsy doesn't mean too much as M. marinum is hard to culture and very slow growing. They make the diagnosis a lot of times without a positive culture. Good thing that you ordered the gloves. You really want to keep that hand out of the water at least til it heals, which may be a really long time. They are probably going to want to operate on it and cut out any infection. The antibiotics totally suck and you will be on them for a long time. For me it was 2 months after the site healed. All in all it was probably about 9 months taking pills twice a day.

Yes, this is what I was saying earlier, and good advice. Do you recall what meds you were on?
And because these organisms are delicate outside the body and slow-growing, a culture may even give a false negative result.
By now the OP's biopsy should have been sectioned, stained and examined microscopically.
They may be able to see the mycobacteria directly (if they used the correct stain to find them).
And even if they don't see the organisms, if granulomata are present under the scope, it's a mycobacterial infection until proven otherwise.

Here's an article on cutaneous mycobacterial infections, discussing treatment: https://www.ncbi.nlm.nih.gov/pubmed/18001256
Doxy and cipro looks like a reasonable combo treatment to try.
Surgery should be used sparingly, per this article. (But I'm sure there are various opinions on that.)

 

[Huskymaniac]

From a medical standpoint, 'not hurting' isn't necessarily a good thing.
Pain is important, and when something looks like it should be painful but isn't, it suggests that nerve endings are being desensitized or destroyed.
For example, one of the hallmarks of leprosy, another mycobacterial disease, is chronic nerve damage and loss of sensation in the extremities.

Big difference though between MM and Leprosy. Not having pain in hand infection, at least to me, means it is not Vibrio and I am not going to potentially die or lose a limb if you know what I mean. Is it possible there is an infection yea I guess. Would seem odd though as it didnt respond to Bactrim.

 

[Huskymaniac]

Yes, this is what I was saying earlier, and good advice. Do you recall what meds you were on?
And because these organisms are delicate outside the body and slow-growing, a culture may even give a false negative result.
By now the OP's biopsy should have been sectioned, stained and examined microscopically.
They may be able to see the mycobacteria directly (if they used the correct stain to find them).
And even if they don't see the organisms, if granulomata are present under the scope, it's a mycobacterial infection until proven otherwise.

Here's an article on cutaneous mycobacterial infections, discussing treatment: https://www.ncbi.nlm.nih.gov/pubmed/18001256
Doxy and cipro looks like a reasonable combo treatment to try.
Surgery should be used sparingly, per this article. (But I'm sure there are various opinions on that.)

Another thing that could possibly be the case here although unlikely is cutaneous sarcoidosis. It also produces granuloma and I did have a case of pulmonary sarcoidosis that resolved 15 years ago. If the biopsy comes back showing granuloma but the culture is negative its going to be a nice medical mystery for some university doc to figure out. Without getting to crazy I think Myco infections cause caseating granuloma whereas sarcoid would cause non caseating. I dont think anyone has every rooted for having a staph infection with cellulitis, haha.

 

[rkpetersen]

Another thing that could possibly be the case here although unlikely is cutaneous sarcoidosis. It also produces granuloma and I did have a case of pulmonary sarcoidosis that resolved 15 years ago. If the biopsy comes back showing granuloma but the culture is negative its going to be a nice medical mystery for some university doc to figure out. Without getting to crazy I think Myco infections cause caseating granuloma whereas sarcoid would cause non caseating. I dont think anyone has every rooted for having a staph infection with cellulitis, haha.

Wait - You have been previously diagnosed with sarcoid? That's straight out of left field!
Yes that makes the differential diagnosis trickier.
You're correct re caseating vs non-caseating granulomata, but it's not a 100% distinction.
Wasn't suggesting you have leprosy!
Hmm, atypical mycobacteria vs possible MRSA - Neither sounds great tbh.

I'm starting to feel like this should be an episode of House.

 

[JaimeAdams]

Yes, this is what I was saying earlier, and good advice. Do you recall what meds you were on?
And because these organisms are delicate outside the body and slow-growing, a culture may even give a false negative result.
By now the OP's biopsy should have been sectioned, stained and examined microscopically.
They may be able to see the mycobacteria directly (if they used the correct stain to find them).
And even if they don't see the organisms, if granulomata are present under the scope, it's a mycobacterial infection until proven otherwise.

Here's an article on cutaneous mycobacterial infections, discussing treatment: https://www.ncbi.nlm.nih.gov/pubmed/18001256
Doxy and cipro looks like a reasonable combo treatment to try.
Surgery should be used sparingly, per this article. (But I'm sure there are various opinions on that.)

Well I started on a heavy dose of Doxy, but when I actually went an infectious disease Doctor I got switched to the Clarithromycin and Ethambutol

 

[Huskymaniac]

Wait - You have been previously diagnosed with sarcoid? That's straight out of left field!
Yes that makes the differential diagnosis trickier.
You're correct re caseating vs non-caseating granulomata, but it's not a 100% distinction.
Wasn't suggesting you have leprosy!
Hmm, atypical mycobacteria vs possible MRSA - Neither sounds great tbh.

I'm starting to feel like this should be an episode of House.

Wait - You have been previously diagnosed with sarcoid? That's straight out of left field!
Yes that makes the differential diagnosis trickier.
You're correct re caseating vs non-caseating granulomata, but it's not a 100% distinction.
Wasn't suggesting you have leprosy!
Hmm, atypical mycobacteria vs possible MRSA - Neither sounds great tbh.

I'm starting to feel like this should be an episode of House.

I will take it one step further. Haha. I also have crohns disease and take Humira. Humira prevents Granuloma formation. According to an article I read online I will be only the 3rd person in the world to get MM and take Humira. This article makes me feel peachy!!!

https://www.jaad.org/article/S0190-9622(09)00024-3/fulltext

 

[Reefahholic]

Ahhhh Uronema...my favorite Ciliate of all time. *Sigh*

 

[rkpetersen]

I will take it one step further.

Ah, the plot thickens.
Your risk of developing an aggressive mycobacterial infection was increased by the anti-TNF drug.
If it is mycobacterial and not something else. Which you don't know for sure yet. Seems likely though.
Anyway, sorry to hear it.
Are you staying on Humira for now, or did your doc temporarily have you stop it?

 

[Huskymaniac]

Ah, the plot thickens.
Your risk of developing an aggressive mycobacterial infection was increased by the anti-TNF drug.
If it is mycobacterial and not something else. Which you don't know for sure yet. Seems likely though.
Anyway, sorry to hear it.
Are you staying on Humira for now, or did your doc temporarily have you stop it?

My crohns doc said the anti tnf can cause problems with certain bacterial infections but doesnt believe staying on it will cause issues with this type of infection. Essentially left it up to me.

 

[rkpetersen]

My crohns doc said the anti tnf can cause problems with certain bacterial infections but doesnt believe staying on it will cause issues with this type of infection.

That seems to be at odds with what was described in that article.
Perhaps get another opinion about that question from an infectious disease specialist.

 

[Huskymaniac]

That seems to be at odds with what was described in that article.
Perhaps get another opinion about that question from an infectious disease specialist.

It's amazing how nothing is ever straight forward. I guess I may be their Guinea Pig.

No specific therapeutic guidelines have been issued in this specific setting. As illustrated by our first patient, first-line antibiotics may fail to control the disease, and other antimycobacterial agents may have to be added. Discontinuation of anti-TNFα treatment must be considered but is not always mandatory.2

I am not so sure it was the tnf inhibitor or the combo with methotrexate. Methotrexate not only suppresses granuloma formation but also the immune system in general. The good think about Humira is it had a very short half life. I know for me it is out of my system in 7 days based on Titer testing levels.

 

[Huskymaniac]

Still haven't heard anything from the doctor. The biopsy definitly should be back by now. The cultures probably still a week out. Either way the doxy has been beating this thing down. Looking a lot better after 6 days.

 

[Huskymaniac]

Still haven't heard anything from the doctor. The biopsy definitly should be back by now. The cultures probably still a week out. Either way the doxy has been beating this thing down. Looking a lot better after 6 days.

 

[drstardust]

Eek, sorry you're going through this, man! Speedy recovery! This could just be a garden variety infection, too, and not Mm. Mycobacterial cultures take foreverrrr to come back, fyi. Glad the abx are helping.

 

[zoaplug]

The neosporin actually makes it worse I think. So far I have found keeping it open is causing the scabs to form. With the neosporin it just kept everything more open and more infected looking. Here it is today. The center is starting to heal from the biopsy. The outside of the wound seems to be getting lighter.

poor thing that looks like it hurts put some aloa on that

 

[Huskymaniac]

Got confirmation. Definitly a mycobacterial infection. Still waiting for cultures to determine the type.

 

[rkpetersen]

Got confirmation. Definitly a mycobacterial infection. Still waiting for cultures to determine the type.

Wow. Time to save your pics as a good example of cutaneous mycobacterial infection, if you don't mind.
Please do follow up with the specific organism when they have it.

 

[Huskymaniac]

Looking better every day. I noticed keeping a bandaid on it makes it look better. Not sure if it's the pressure or what.

 

[ghostman]

I'm glad things are going well for you huskymaniac. It was nice chatting through messaging with you about the MM. How long is your AB course going to continue? When I had MM, it seemed to take forever. As we discussed, I had no results until having surgery and a long course of rifampin. My culture took nearly 6 weeks to confirm. I wish you well!!! It's looking better every day. Keep an eye out for any additional lumps though. Mine gradually moved up my hand and wrist.