A Disseminated Mycobacterium Abscessus Infection in a Patient Affected by Pulmonary Graft versus Host Disease: Case Report with a Revision of Literature

Abstract

Mycobacterium abscessus complex, hereinafter Mab, is a taxonomic group of rapidly growing, nontuberculous mycobacteria (NTM). Despite major advances in understanding virulence, pathogenicity and mechanism of antibiotic resistance, Mab remains a significant cause of pulmonary and extra-pulmonary disease. Herein, we describe a disseminated, macrolide-resistant, Mab subspecies abscessus infection occurring in a severely immune-compromised 34-year-old allotransplanted female patient affected by pulmonary chronic graft versus host disease (cGVHD). The infection was characterized by hematogenous spread, and besides lungs, it involved skin, and soft tissues, resulting in a highly debilitating, painful, and finally fatal disease. Our case describes the severe impact of Mab infections in the setting of allogeneic hematopoietic stem cells transplant (alloHSCT) and related complications. It also highlights the unmet need of preventive and surveillance measures together with the urgency of developing effective vaccines and drugs against emerging NTM. The scarce literature regarding Mab infections in alloHSCT patients is also reviewed.

Nontuberculous mycobacterial infections in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation

“…Although isolated lymphadenitis and limited organ involvement such as skin infection or pneumonia can be seen in immunocompromised patients, the diagnosis of mycobacterial infection in any extrapulmonary location without antecedent trauma or surgery should always prompt further evaluation for disseminated disease. 8,50,60,71,72 Less common presentations of NTM in immunosuppressed patients include long bone, vertebral body, maxillary sinus, and abdominal organ involvement such as liver, spleen, and peritoneum. 37,39,66,73,74 The high mortality rate is seen in these patients is primarily driven by the overall poor clinical condition of patients due to their underlying hematological malignancy, as well as significant difficulties and delays in establishing a definitive diagnosis of disseminated NTM disase.…”

“…Clinical presentations are often nonspecific and include fever, weight loss, diarrhea, abdominal pain, and fatigue. Although isolated lymphadenitis and limited organ involvement such as skin infection or pneumonia can be seen in immunocompromised patients, the diagnosis of mycobacterial infection in any extrapulmonary location without antecedent trauma or surgery should always prompt further evaluation for disseminated disease 8,50,60,71,72 . Less common presentations of NTM in immunosuppressed patients include long bone, vertebral body, maxillary sinus, and abdominal organ involvement such as liver, spleen, and peritoneum 37,39,66,73,74 .…”