1
|
Somboonviboon D, Thongtaeparak W, Suntavaruk P, Nasomsong W. Disseminated coinfection with Mycobacterium Avium complex and Mycobacterium Kansasii in a patient with idiopathic CD4 + lymphocytopenia: A case report. J Infect Chemother 2023; 29:1167-1171. [PMID: 37562711 DOI: 10.1016/j.jiac.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/31/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023]
Abstract
Simultaneously disseminated coinfection with two species of nontuberculous mycobacteria (NTM) is extremely rare and had been reported only in immunocompromised individuals. Here, we report a 59-year-old Thai man, previously healthy. He presented with a 2-month history of prolonged fever, constitutional symptoms, and hepatosplenomegaly. His chest and abdomen computed tomography illustrated multiple enlarged mediastinal lymph nodes accompanied with multifocal crazy-paving appearance in both lungs and hepatosplenomegaly. Endobronchial ultrasound-guided transbronchial needle aspiration was performed on the mediastinal nodes. The pathologic findings were necrotizing granulomatous lymphadenitis with numerous AFB-positive bacilli. Blood culture subsequently isolated M. intracellulare, while BAL and lymph node culture isolated M. intracellulare and M. kansasii, which confirmed species by multiplex PCR and 16s rRNA sequencing. Idiopathic CD4+ lymphocytopenia (ICL) was diagnosed as the cause of secondary immune deficiency. Intravenous imipenem, amikacin, and azithromycin were administered as an empirical antibiotic regimen for 4 weeks, then substituted to oral rifampicin, clarithromycin, moxifloxacin, and ethambutol as definitive regimen. Unfortunately, it was found that he had died unexpectedly at home after 4 months of treatment, possibly related to this illness. In our view, patients with severe disseminated NTM disease should be evaluated to explore a secondary immune deficiency disorder. An ICL is a rare heterogenous syndrome but should be considered.
Collapse
Affiliation(s)
- Dujrath Somboonviboon
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Thailand
| | - Wittaya Thongtaeparak
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Thailand
| | - Papatsiri Suntavaruk
- Division of Infectious Disease, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Thailand
| | - Worapong Nasomsong
- Division of Infectious Disease, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Thailand.
| |
Collapse
|
2
|
Pattanaprichakul P, Leeyaphan C, Angkasekwinai N, Bunyaratavej S, Senawong S, Sereeaphinan C, Munprom K. Prevalence and clinical manifestations of cutaneous findings in patients with adult-onset immunodeficiency due to anti-interferon gamma autoantibodies: an eight-year retrospective study. Int J Dermatol 2023; 62:1506-1510. [PMID: 37828737 DOI: 10.1111/ijd.16870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/16/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Cutaneous findings in adult-onset immunodeficiency due to anti-interferon gamma autoantibodies (anti-IFN-γ autoAbs) are common. Currently, data on this topic are scarce. METHODS We retrospectively reviewed medical records of 202 skin episodes from 77 patients diagnosed with adult-onset immunodeficiency due to anti-IFN-γ autoAbs. The exclusion of drug eruptions left 180 episodes from 74 patients for further analysis. RESULTS Reactive dermatosis was diagnosed in 66.1%, followed by disseminated skin infection (18.3%) and local skin infection (15.6%). Neutrophilic dermatosis (ND) tended to appear on the upper part of bodies, while leg lesions were common in the non-ND. Disseminated infection occurred more frequently with ND. Mycobacterium abscessus was the most common pathogen of concomitant infection. Remission was achieved in 21.6% and was significantly associated with females. CONCLUSION Reactive dermatosis was the most common skin manifestation. ND was found in the upper part of bodies and associated with disseminated infection. Drug-free remission was scarcely achieved.
Collapse
Affiliation(s)
- Penvadee Pattanaprichakul
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Charussri Leeyaphan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nasikarn Angkasekwinai
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sumanas Bunyaratavej
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sansnee Senawong
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chudapa Sereeaphinan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanyalak Munprom
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
3
|
Severe Disseminated Mycobacterium kansasii Infection due to Autoantibodies Against IFN-ɣ. J Clin Immunol 2023; 43:76-79. [PMID: 36057074 DOI: 10.1007/s10875-022-01362-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/29/2022] [Indexed: 01/18/2023]
|
4
|
Hidekawa C, Yoshimi R, Kishimoto D, Kato H, Mitsuhashi M, Sakurai N, Sato Y, Uehara T, Iizuka Y, Komiya T, Hamada N, Nagai H, Soejima Y, Kamiyama R, Takase-Minegishi K, Kirino Y, Sakagami T, Nakajima H. Anti-interferon-γ Antibody-seropositive Disseminated Nontuberculous Mycobacterial Infection Mimicking POEMS and TAFRO Syndromes. Intern Med 2022; 61:2377-2385. [PMID: 35022342 PMCID: PMC9424072 DOI: 10.2169/internalmedicine.8366-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Disseminated nontuberculous mycobacterial infection (DNTM) is typically observed in immunocompromised hosts. Recently, it has been reported that healthy individuals with serum neutralizing autoantibodies for interferon (IFN)-γ can also develop DNTM. We herein report a case of anti-IFN-γ antibody-seropositive DNTM caused by Mycobacterium kansasii with symptoms mimicking TAFRO or POEMS syndrome, including anasarca, organomegaly, skin pigmentation, polyneuropathy, osteosclerotic change, thrombocytopenia, serum M protein, high C-reactive protein level, and reticulin fibrosis. The combination of antimicrobial chemotherapy with glucocorticoid and intravenous immunoglobulin improved his symptoms. Glucocorticoids may be an effective method of suppressing the production of anti-IFN-γ antibodies in DNTM.
Collapse
Affiliation(s)
- Chiharu Hidekawa
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| | - Ryusuke Yoshimi
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| | - Daiga Kishimoto
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| | - Hideaki Kato
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
- Infection Prevention and Control Department, Yokohama City University Hospital, Japan
| | - Masaki Mitsuhashi
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| | - Natsuki Sakurai
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| | - Yuichiro Sato
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| | - Takeaki Uehara
- Department of Rheumatology, Chigasaki City Hospital, Japan
| | - Yuki Iizuka
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| | - Takaaki Komiya
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| | - Naoki Hamada
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| | - Hideto Nagai
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| | - Yutaro Soejima
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| | - Reikou Kamiyama
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| | - Kaoru Takase-Minegishi
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| | - Yohei Kirino
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| | - Takuro Sakagami
- Department of Respiratory Medicine, Faculty of Life Sciences, Kumamoto University, Japan
| | - Hideaki Nakajima
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| |
Collapse
|
5
|
Luttmann KF, Starnes VR, Rostad K, Girdhar KK, Duggan J. Pleural Effusion/Empyema With Mycobacterium kansasii. Cureus 2022; 14:e21300. [PMID: 35186562 PMCID: PMC8849488 DOI: 10.7759/cureus.21300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/21/2022] Open
Abstract
Mycobacterium kansasii is a nontuberculous mycobacterium that causes pulmonary symptoms, commonly associated with underlying conditions, including malignancy, prior transplant, and HIV. However, rarely does Mycobacterium kansasii present with pleural effusion. We present a case of a 56-year-old female who presented with dyspnea and chest pain, and sputum culture was positive for acid-fast bacilli. A CT scan revealed a left-sided pleural effusion. Based on a thorough review of the literature using Embase and PubMed, we found that only 22 cases of a Mycobacterium kansasii pleural effusion have been reported. We provide a discussion on maintaining a broad differential in the treatment of immunocompromised individuals with Mycobacterium infection.
Collapse
|
6
|
Disseminated Mycobacterium genavense infection mimicking TAFRO syndrome. J Infect Chemother 2020; 26:1095-1099. [DOI: 10.1016/j.jiac.2020.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/12/2020] [Accepted: 06/22/2020] [Indexed: 12/11/2022]
|