AI Article Synopsis
- - A 38-year-old woman with systemic lupus erythematosus (SLE) started treatment with belimumab, and a month later, she developed painful swelling and skin lesions on her legs.
- - Skin biopsies showed microabscesses and a high number of acid-fast bacilli, leading to a diagnosis of a mycobacterial skin infection.
- - The patient was successfully treated with antibiotics, resulting in significant improvement of her skin lesions over 13 months, but highlights the risk of mycobacterial infections associated with belimumab treatment for SLE.
Article Abstract
A 38-year-old female with systemic lupus erythematosus (SLE) initiated belimumab treatment. One month later, she presented with a reddish painful swelling on her right lower leg. She was treated with ceftriaxone and vancomycin. However, novel erythematous papules and indurated nodules appeared on both her lower legs. Skin biopsy revealed microabscess formation with mixed cell granuloma surrounded by inflammatory cell infiltration within the dermis with subcutaneous fat tissue. A large number of acid-fast bacilli were observed with Ziehl-Neelsen staining. DNA sequencing of both the hsp65 and the 16S rRNA sequences showed a 100% match with the corresponding region of . Mycobacterial culture revealed satellite growth enhancement on Middlebrook 7H11 agar plates around a paper strip containing hemin. She was treated with levofloxacin, rifabutin, and ethambutol. Within 13 months, her cutaneous lesions improved markedly without any side effects. The B cell-targeted biologic belimumab, a fully humanized IgG1γ monoclonal antibody that inactivates B lymphocyte stimulator, has been considered to be beneficial for active SLE. However, this therapy could increase the risk for the development of biologic therapy-associated mycobacterial infections, both tuberculosis and nontuberculous mycobacteria infections.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10608360 | PMC |
| http://dx.doi.org/10.5021/ad.21.077 | DOI Listing |
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