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Background TNFα inhibitors are a well-known risk factor for active tuberculosis but less is known about the link between TNFα inhibitors and other mycobacterial diseases, particularly M. marinum. With the increase in use of these medications, and the trend toward more outdoors activities that include aquatic environment exposure, focus should be on better understanding of the link between use of TNFα inhibitors and the development of a severe M. marinum infection that might require earlier diagnosis and more aggressive antibiotic therapy. Methods We will describe our experience with three cases of aggressive cutaneous M. marinum infection in patients taking anti-TNFα that presented to Abington Memorial Hospital in Pennsylvania between 2014 and 2017. Results Age, gender, diagnosis Age, gender, diagnosis Anti TNFα, duration and indication Exposure Delay in diagnosis Treatment Progression 47 y.o F Cellulitis/lymphangitis Etanercept, 5 years, for RA Municipal pool 2 weeks Clarithromycin+ etmabutol Cleared in 2 months 34 y.o M cellulitis Infliximab, 7 years, UC Salt water fish tank 10 weeks Clarithromycin+ etmabutol Cleared in 3 weeks 62 y.o F Cellulitis/lymphangitis Adalimumab, 8 months, RA Barnacle injury 4 weeks Clarithromycin+ Rifampin Cleared in 1 month Conclusion TNFα is not only linked to active TB, but also associated with other mycobacterial diseases including M. marinum. While CDC reports a delay of 17 months from time of onset of symptoms to establishing the diagnosis, our three cases were diagnosed much earlier. Early diagnosis relies probably on involvement of Infectious diseases specialists early in the course of the illness and the readiness in sampling of the lesions. The challenge to the clinicians remain in the safety and the timing of resuming anti TNFα treatment after M. marinum infection. Disclosures All authors: No reported disclosures.

1603. Our Experience With M. marinum Cutaneous Infections in Three Patients Receiving Anti-TNFα