Aggressive surgery turns the tide on bacterial assault

Dec. 13, 2019

When Dr. Bennie Lindeque met Chris Brown, he made her an offer that many could have refused.

It was July 2018 and Brown, then 59, was at UCHealth University of Colorado Hospital on the Anschutz Medical Campus, far from her home in Anchorage, Alaska. She was in torment, her body assailed by a deadly bacterial infection that covered her body in lesions and nodules, invaded her lungs and threatened her life. Brown had spent many days in intensive care in an Anchorage hospital and survived sepsis before flying to Denver with her husband, Danny Reynolds, in a last-ditch effort to halt the bacterial assault.

A photo of Chris Brown, who battled a NTM infection, in AlaskaLindeque, an orthopedic surgeon with a specialty in bone infections, and a professor of Orthopedics at the University of Colorado School of Medicine, bluntly told Brown that antibiotics alone could not halt the infection. She needed more radical treatment.

“I told her, ‘I will cut you until you are clean,’” Lindeque recalled. He was proposing aggressive surgery to remove all the infected tissue he could find from Brown’s body, even if it meant cutting into her deeply. Lindeque compared the procedures to cancer surgery – every rogue cell must go or the disease can return. He warned Brown that she would be left with muscle and skin defects.

Brown listened to Lindeque’s explanations, then declared, “Bring it on!”

On Sept. 23, 2019 Lindeque excised infected tissue from Brown for the 14th time. Brown is back in Anchorage and while her body is battle-scarred, her spirit is unbowed. She’s once again pushing through the Alaskan country she loves, spurred by the same will that resists the disease she despises.

“I’m not the person I was when I was in my 40s or even my 50s,” Brown said, now 61. “But I am able to go back to Alaska and hike the trails I want to hike. I’m still working on my endurance and getting back into shape.”

A bacterial assault: NTM infection

The origins of Brown’s battle are uncertain, but the immediate cause is not. She fell prey to an organism called Mycobacterium haemophilum. It’s part of a group called nontuberculous mycobacterium, or NTM, that can cause skin infections of the type Brown suffered. In her case, they ranged from small skin bumps and scaling to large, angry, oozing abscesses that deeply invaded the tissue of her right leg, foot, ankle and hand and both forearms.

Lindeque says a compromised immune system is among the risk factors for a NTM infection – more on that later – but Mycobacterium haemophilum can also attack otherwise healthy people.

“The problem is, people can get it from multiple sources,” said Lindeque, who collects tissue samples from people with a NTM infection. The everyday culprits include fish tanks, pedicures, thorns in yards and fields, even municipal water supplies – any source that offers an entry point to the body.

As for Brown, Lindeque said he’s not sure how Mycobacterium haemophilum “got hold of her.” But he noted that her immune system “was not optimal,” and that traces back to her battle with another disease: rheumatoid arthritis, or RA.

Arthritis attack

Brown said she was diagnosed in 1993 with RA, an autoimmune disease that invades and weakens the joints. She was firmly settled in Alaska, having moved there in 1979 and established a career in forestry and natural resource jobs. She reconnected with Reynolds in Alaska in 1982 – both had attended Green Mountain High School in Lakewood – and the two married in 1985. At the time of her diagnosis, Brown was working for energy company ARCO as an environmental coordinator.

Learning she had RA was “devastating,” Brown said. She and Reynolds had enjoyed the natural wonders of Alaska to the fullest – running, hiking and kayaking – and she had no intention of stopping.

“I said, ‘I don’t have time for RA,’” she recalled. “I didn’t want to have this condition or anything to hold me back.”

For six months, she refused medication, but after her hands and feet painfully swelled, she gave in and began taking methotrexate, a drug that blocks the damaging inflammation caused by RA. It worked so well that Brown ran in the mountains and in wilderness races. But she later switched to a series of so-called biologic drugs to combat lingering symptoms like right-ankle pain and swelling. These drugs, delivered by injection, work by inhibiting an immune system-produced protein called TNF (tumor necrosis factor) that triggers inflammation.

The downside of the biologics is that they powerfully suppress the immune system, thereby increasing the risk of infection. After trying a series of the drugs, Brown said that their effectiveness diminished. She developed an injection-site rash and the ankle problems persisted. Her strength and stamina dwindle and she suffered sinus infections, headaches and chronic fatigue. By 2017, the physical demands of her job – now as a contractor with ConocoPhillips, on a two-week-on, two-week-off rotation at a remote oilfield – became too great, and she retired.

“I didn’t feel strong anymore,” Brown said. “I stopped skiing and running. My physical condition was deteriorating.”

NTM infection invasion

In February 2018, Brown traveled with Reynolds to Tucson to visit his grandmother. They returned to a big snowfall in Anchorage, which coincided with Brown’s right hand becoming severely swollen and spotted. “It looked like a baseball mitt,” she remembered. After that subsided, her arms and right ankle reddened and inflamed. None of the symptoms were signs of RA, as Reynolds observed.

With that, Brown consulted an infectious disease specialist, but the symptoms worsened. Sores on her knuckles and brown areas on her legs appeared. After incidents of passing out in the shower, she went to Providence Hospital in Anchorage, where providers diagnosed her with sepsis and intubated her. She survived that but swelled so severely that she described herself as “the Michelin Man.” During an 18-day stay in intensive care, providers finally discovered the NTM infection.

They weren’t sure how to deal with it, however. Brown spent two more stints in the ICU, her fingers split, her legs swollen and pus oozing from abscesses. Her infectious disease doctor made arrangements for her to go to National Jewish in Denver in late July 2018. She was then sent to Lindeque.

A photo of Bennie Lindeque
Dr. Bennie Lindeque, orthopedic surgeon at UCHealth University of Colorado Hospital, aggressively removed tissue from various areas of Brown’s body in an effort to fight her serious infection. Photo by UCHealth.

“He told me, ‘I’m taking everything out of you,’” Brown recalled, and she readily agreed.

Antibacterial battle

Lindeque emphasized the importance of the partnership that he, Chief of Spine Dr. CJ Kleck, and thoracic surgeon Dr. John Mitchell maintain with National Jewish Health in managing the care of Brown and other patients with serious infections.

“We work with National Jewish as a single unit,” Lindeque said. “They are the world’s experts in administering the correct antibiotics.”

But even with aggressive infection-fighting treatment, Brown was “in dire straits” when he saw her, Lindeque said, so much so that she could have elected to stop the medications and opted for hospice care. Instead, she decided to fight.

“Her demeanor and attitude were unbelievable,” Lindeque said. “Despite mutilating procedures, I never found her to be depressed to the point that she was negative. The way that she dealt with us as a medical team was absolutely exemplary.”

The antibiotic treatment regimen, which Huitt handled in consultation with UCHealth infectious disease specialist Dr. Laura Damioli, was a tightrope that required keeping the infection at bay without triggering kidney and liver damage or other problems. A key tool in that effort were calcium beads – which the body accepts as a natural substance – mixed with antibiotics that targeted the Mycobacterium haemophilum bacteria. The beads allowed Lindeque to isolate treatment to the specific areas where he cut away Brown’s infected tissue without pumping antibiotics through the rest of her body.

“The beads are complementary in combination with aggressive surgery,” Lindeque said.

Turning the tide

And aggressive it was. For example, Lindeque cut large swaths of tissue from the outside of Brown’s right leg, ankle and knee, chunks he described as a “shark bite” to help her conceptualize the trauma. She bears a long, deep indentation as a reminder. Through Brown’s more than three-month stay at UCH, Lindeque followed a consistent surgical strategy: prioritize the largest problem areas – a large mass on the ball of her right foot was another particularly troublesome spot – and during those procedures also excise smaller areas to prevent them from growing. And never let anything go.

“The idea was to relentlessly go after it every time a new lesion develops,” Lindeque said. “It’s easier to get a small lesion [to prevent] it from seeding [others].”

A photo of Chris Brown and Danny Reynolds
Chris Brown and Danny Reynolds in early October, 10 days after Brown’s latest surgery at UCH to remove infected tissue from her body. Photo by UCHealth

Lindeque’s surgeries also required skin grafts, using both artificial skin and tissue harvested from Brown’s body. But the surgeries were just one part of her overall treatment. She had extensive wound care, including vacuums, debridement and washouts, and months of physical therapy, both at UCH and a two-month stint after discharge with best friend, Patty, a PT in Denver.

“I was really diligent about PT,” Brown said. “I wanted to walk, and I pushed myself.”

And Reynolds stood by her throughout. He took a month’s leave from his job with the Anchorage School District, staying at a condo his mom owns in Denver. Lindeque cited his unflagging support as an essential factor in Brown’s “amazing progress.”

“Danny’s contribution was very positive,” he said. “He was always eager to help and support her. It’s not only the patient’s own demeanor and positivity that help them through. Next-of-kin support is very important.” Brown also had constant support from friends and family, both in Colorado and Alaska.

Constant vigilance

Brown returned to Alaska on January 25, 2019, six long months after arriving in Denver perilously close to death. She’s back to hiking and continues to work on building her endurance. The infection lingers; she remains on antibiotics and has had to return to Denver twice for surgeries. Following Lindeque and his team’s admonitions, she vigilantly surveys her skin for tell-tale bumps and spots.

“I am constantly examining myself,” she said. “I am really cognizant of my body.”

Brown calls Lindeque “the cornerstone of my therapy” and a “hero,” but she and Reynolds also praise the entire UCH care team, from the nurses to Food Service and Environmental Services staff, for contributing to her positive outcome.

“They were lifesavers,” Brown said.

Her life saved, Lindeque is cautiously optimistic that Brown’s recovery will continue.

“I think the more we take care of the lesions sooner rather than later, the better the chance that if we cannot achieve a cure we can extend the period in which she has to come back for more surgeries,” he said. “Then we can possibly also curtail the antibiotics.”

As another precaution, Brown no longer takes biologic medications for her RA. She noted that Huitt and her infectious disease specialists at UCH felt that her immune system would take at least a year to recover fully – if at all.

Numbness in her ankle and foot still remind Brown of her of her disease battle, but she is still in the fight, and that’s enough for her.

“Push-ups aren’t in my DNA anymore,” she said. “I don’t know if I will get back to the ultimate fitness I was before, but I might get back. Who knows? I’m working on it.”

About the author

Tyler Smith has been a health care writer, with a focus on hospitals, since 1996. He served as a writer and editor for the Marketing and Communications team at University of Colorado Hospital and UCHealth from 2007 to 2017. More recently, he has reported for and contributed stories to the University of Colorado School of Medicine, the Colorado School of Public Health and the Colorado Bioscience Association.