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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.
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.