Cutaneous infection by Mycobacterium haemophilum and kansasii in an IgA-deficient man

We present a patient with IgA-deficiency and mixed cutaneous infection by two slowly growing mycobacteria, Mycobacterium (M.) haemophilum and M. kansasii.Cutaneous M. haemophilum infections most often result from HIV or transplantation-associated immunosuppression. Rarely, M. haemophilum may also infect healthy patients or iatrogenically immunosuppressed patients without transplantation. M. kansasii is one of the most frequent NTM and large awareness exists about its involvement in human diseases. Mycobacterial diagnosis of cutaneous infections should be considered in long-lasting skin lesions.Immunoglobulin (Ig) A-deficiency is the most common primary antibody deficiency. Although the majority of affected individuals have no apparent symptoms, selected patients suffer from recurrent mucosal infections, allergies, and autoimmune diseases [1]. So far, in patients with selective IgA deficiency no infections with nontuberculous mycobacteria (NTM) have been reported. However, in the last decade NTM are increasingly recognized as infective agents, particularly among immunocompromised patients.Mycobacterium haemophilum is an established cause of cutaneous infections in immunocompromised hosts [2]. The most common clinical manifestation of M. haemophilum infections are skin lesions with a preference for cooler body sites such as extremeties, while the development of sporotrichoid-like nodular lymphangitis is exceptional.M. kansasii is one of the most frequent NTM causing human diseases among both immunocompetent and immunocompromised patients [3]. M. kansasii most likely causes infections resembling tuberculosis likewise with a preference for pulmonary disease [4]. Cutaneous infections due to this slow growing mycobacterium are rare and may resemble cellulitis or sporotrichosis. Nevertheless, M. kansasii should be included in the differential diagnosis of skin infections with an indolent course and lack of response to standard antibiotics [5]. Since NTM are typically ubiqu