Bronchial anastomosis dehiscence and stenosis caused by donor‐transmitted Mycoplasma hominis infection in a lung transplant recipient: Case report and literature review

Abstract

Pulmonary infection by Mycoplasma hominis (M hominis) in lung transplant (LTx) recipients is an uncommon yet potentially severe complication. Bronchial dehiscence in the context of M hominis infection has not been previously reported. In this report, we discuss a case of donor‐derived M hominis infection in a LTx recipient with bilateral bronchial anastomoses dehiscence and stenosis. The infection was managed using a multidisciplinary approach: repeat surgical revision of the necrotic anastomosis; targeted antibiotic therapy with the combination of oral and inhaled fluoroquinolones, and oral doxycycline and continuous ventilatory support. Response to therapy was monitored through repeat bronchoscopy and serial quantitative PCR assays for M hominis in bronchoalveolar lavage and aspiration. The rare nature of M hominis infection after LTx, its difficult detection in conventional cultures and innate resistance to beta‐lactams make diagnosis and timely treatment of this organism challenging. We recommend that transplant centers have a low threshold for screening for Mycoplasma infection, particularly in patients with unsatisfactory postoperative course and little response to broad‐spectrum antimicrobial and antifungal coverage. Monitoring with PCR may help to adapt the duration of antibiotic therapy.

Case reports and literature Review: A concern in transplant patients- Extraurogenital infection by Mycoplasma hominis

“…The chief complaint in the 11 cases due to infection range from fever, pulmonary insu ciency, and right hip groin pain to severe encephalopathy. Two patients (18%) expired due to complications associated with M. hominis post-transplantation [4,9,[15][16][17][18][19][20][21][22].…”

Identification of sacrococcygeal and pelvic abscesses infected with invasive Mycoplasma hominis by MALDI‐TOF MS

“…hominis can penetrate the mucosa, invade the vascular walls, and spread to all tissues and organs of the body 17‐19 . Surgical incision infection, postoperative blood flow infection, post cardiopulmonary transplantation infection, and other cases have been reported from time to time 20‐22 . In addition, infants whose immune function is not yet fully developed often have serious clinical manifestations by infecting M .…”

“… 17 , 18 , 19 Surgical incision infection, postoperative blood flow infection, post cardiopulmonary transplantation infection, and other cases have been reported from time to time. 20 , 21 , 22 In addition, infants whose immune function is not yet fully developed often have serious clinical manifestations by infecting M . hominis in utero or through vertical transmission.…”

Lung Abscess and Recurrent Empyema After Infection With Mycoplasma hominis: A Case Report and Review of the Literature

“…However, optimal length of therapy is currently unknown. Although PCR seems useful as a follow-up parameter, it may remain positive for several weeks after appropriate antibiotic treatment [ 26 ].…”