A hemodialysis patient with Mycobacterium avium complex pericarditis in which remarkable presepsin elevation was not accompanied by procalcitonin elevation

Abstract

Background: The application of presepsin for diagnosing infections in hemodialysis (HD) patients has not been confirmed yet. In addition, whether presepsin can detect atypical mycobacterial infection or not remains unknown. Case presentation: We describe the case of a 66-year-old male HD patient with pericardial tamponade. Mycobacterium avium complex (MAC) was identified from a culture of pericardial effusion. The patient showed a clinical improvement after approximately 1 year without the administration of antibiotics. Remarkably, high plasma presepsin values were observed without an increase in serum procalcitonin values. The patient's presepsin values decreased after the treatment of MAC induced pericarditis. Conclusions: We found a HD patient with mycobacterium avium complex pericarditis with remarkable presepsin elevation unaccompanied by PCT elevation.

HaemorrhagicMycobacterium aviumcomplex pericarditis presenting with cardiac tamponade in an immunocompetent woman

“…We postulate that since our patient, in addition to the above-stated patients, was immunocompetent, drainage of the effusion was enough to significantly decrease the bacterial load within the pericardial space, allowing the immune system to clear the infection more easily (much like with the drainage of an abscess). In the case described by Shiota, MAC antibody titres were measured post-pericardial drainage, which was noted to decrease gradually despite no anti-mycobacterial agents 7. Such a finding supports our argument that in an immunocompetent patient with an absence of disseminated infection, surgical drainage and the use of NSAIDs are sufficient to prevent the recurrence of MAC-induced pericarditis.…”

“…In the case described by Shiota, MAC antibody titres were measured post-pericardial drainage, which was noted to decrease gradually despite no anti-mycobacterial agents. 7 Such a finding supports our argument that in an immunocompetent patient with an absence of disseminated infection, surgical drainage and the use of NSAIDs are sufficient to prevent the recurrence of MAC-induced pericarditis. However, larger studies will be required to validate this argument.…”

“…Like other non-tuberculous mycobacteria, it is non-communicable from person to person. However, it is clinically significant, as it can cause severe disseminated disease, particularly in immunocompromised patients, and has a remarkable propensity to develop resistance to most anti-mycobacterial agents 6 7 Table 2. shows a summarised list of other cases of MAC pericarditis in immunocompetent patients.…”