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Skin nodules in rheumatoid arthritis due to infection with Mycobacterium haemophilum.

Sir, Mycobacterium haemophilum was first isolated in 1978 from a patient with Hodgkin’s disease suffering from septic arthritis and nodular skin lesions (1). Since then, infections with M. haemophilum have primarily been reported in two different groups of patients: (i) immunocompromised adults with organ or bone marrow transplants, haematological malignancies or advanced HIV infection (2); and (ii) immunocompetent children with cervico-facial lymphadenitis (3).The clinical presentation of M. haemophilum infections is variable and may include cellulitis, arthritis, osteomyelitis and pneumonia. Here, we report on a patient suffering from long-standing rheumatoid arthritis who presented with skin lesions that could be attributed to infection with M. haemophilum. This case report illustrates the difficulties of identification, isolation and eradication of this rarely reported pathogen.