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Mycobacterial knee infection in patients with idiopathic inflammatory myositis
  1. I Haq1,
  2. D Isenberg2
  1. 1ARC Educational Research Fellow, Academic Centre for Medical Education, Royal Free and University College Medical School, 4th Floor Holborn Union Building, Highgate Hill, London N19 5LW, UK
  2. 2Centre for Reumatology, Division of Medicine, The Middlesex Hospital and University College London, 4th Floor Arthur Stanley House, 40–50 Tottenham Street, London W1T 4NJ, UK
  1. Correspondence to:
    Dr I Haq;
    i.haqacme.ucl.ac.uk
  1. R Callaghan3
  1. 3Wallsgrave Hospital, Coventry, UK

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We read with interest the report by Callaghan and Allen about a patient with inflammatory myositis who developed Mycobacterium malmoense infection in her right knee.1 The authors state in their discussion that they reviewed the literature and found no cases of isolated joint infection with this organism. However, in this journal, we have previously reported three patients with inflammatory myositis who developed mycobacterial knee infections, one of which was with M malmoense.2

It is interesting to see that another case of infection with this rare organism has been described in a patient with inflammatory myositis. We suggest that it is sensible to ensure that synovial fluid aspirated from joints of patients with autoimmune rheumatic disease receiving long term immunosuppressive drugs is sent specifically for mycobacterial culture. Possibly, some atypical mycobacterial infections are being undiagnosed. Such infections could become more common with the increasing use of biological therapies for autoimmune rheumatic disease.

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Author’s reply

Apologies for not picking up this interesting article in our literature search. Drs Isenberg and Haq are, of course, right. Thank you for letting us know.

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