Hindawi Publishing Corporation Case Reports in Medicine Volume 2011, Article ID 480987, 4 pages doi:10.1155/2011/480987 Case Report Atypical Mycobacterial Infection Presenting as Persistent Skin Lesion in a Patient with Ulcerative Colitis Giorgos Bamias,1 George L. Daikos,1 Spyros I. Siakavellas,1 Garyfallia Kaltsa,1 Stavroula Smilakou,2 Ioannis Katsogridakis,1 Irene Vaﬁadis-Zouboulis,1 and Spiros D. Ladas1 1 Gastroenterology Division, 1st Department of Internal Medicine-Propaedeutic, Laikon General Hospital, University of Athens, 17 Agiou Thoma Street, 11527 Athens, Greece 2 Department of Clinical Microbiology, Laikon General Hospital, 17 Agiou Thoma Street, 11527 Athens, Greece Correspondence should be addressed to Giorgos Bamias, gbamias@gmail.com Received 26 June 2011; Accepted 9 August 2011 Academic Editor: Remo Panaccione Copyright © 2011 Giorgos Bamias et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Immunosuppressive drugs are commonly used for the treatment of inﬂammatory bowel disease. Patients receiving immuno- suppressants are susceptible to a variety of infections with opportunistic pathogens. We present a case of skin infection with Mycobacterium chelonae in a 60-year-old Caucasian woman with ulcerative colitis who had been treated with corticosteroids and azathioprine. The disease manifested with fever and rash involving the right leg. Inﬂiximab was administered due to a presumptive diagnosis of pyoderma gangrenosum, leading to worsening of the clinical syndrome and admission to our hospital. Routine cultures from various sites were all negative. However, Ziehl-Neelsen staining of pus from the lesions revealed acid-fast bacilli, and culture yielded a rapidly growing mycobacterium further identiﬁed as M. chelonae. The patient responded to a clarithromycin- based regimen. Clinicians should be aware of skin lesions caused by atypical mycobacteria in immunocompromised patients with inﬂammatory bowel disease. Furthermore, they should be able to thoroughly investigate and promptly treat these conditions. 1. Introduction Immunosuppressive drugs, consisting of corticosteroids, immunomodulators, and biological factors, are the mainstay of treatment for inﬂammatory bowel disease (IBD). These medications lead to a state of immunosuppression, the sever- ity of which depends upon the speciﬁc drug, the dose admin- istered, and the duration of treatment [1]. Patients receiv- ing immunosuppressants become susceptible to infections, caused not only by common pathogens, but also, by various opportunistic microorganisms. The latter may cause unusual clinical syndromes, thus generating diagnostic and therapeu- tic challenges, as they are easily confused with the variety of extraintestinal manifestations of Ulcerative Colitis (UC) and Crohn’s disease (CD) [2]. Herein, we describe a case of skin infection with Mycobacterium chelonae in a woman who was under long-term immunosuppressive treatment for UC. The lesion was initially misdiagnosed as pyoderma gangrenosum resulting in initiation of anti-TNF treatment. The ﬁnal diagnosis was achieved only when microbiological testing with optimal culture conditions was applied. 2. Case Presentation A 60-year-old female, with a 12-year history of UC involving the entire colon, was admitted to our hospital for evaluation of skin lesions and low-grade fever. The patient had been receiving 5-ASA preparations, since UC diagnosis, and corti- costeroids and azathioprine for the last 3 years. At admission, UC was in clinical remission and the patient was on 16 mg of methylprednisolone and 150 mg azathioprine daily. Four months prior to admission, while intestinal disease was in remission, the patient noticed several painless, erythematous nodules on her right lower extremity. There was no history of prior trauma. Local corticosteroids had no beneﬁcial eﬀect. A month and a half later, low-grade fever (up to 37.6◦C) was noticed. An incision was made in one of the lesions, pus obtained and sent for culture, which grew