Case report: Mycobacterium neoaurum infection during ICI therapy in a hepatocellular carcinoma patient with psoriasis

Abstract

We report here a patient with advanced hepatocellular carcinoma (HCC) and psoriasis treated with immune checkpoint inhibitor (ICI) therapy who experienced tumor partial response and psoriatic exacerbation. Meanwhile, the patient contracted mycobacterium neoaurum during the treatment period, while it was an opportunistic infection and mainly happened in immunosuppressed patients. We discussed the possibility that this infection was an ICI-associated infection independent of immunosuppression due to dysregulated immunity, which was the result of the effects of immunotherapy and autoimmune disease (AID), and the characteristics and treatment of M. neoaurum, which was rarely reported in China. This case highlights the fact that some infections can be precipitated by ICIs in the absence of immunosuppressive treatment, especially the patients with AID.

Deciphering the microbial landscape of lower respiratory tract infections: insights from metagenomics and machine learning

“…The rise of bacterial drug resistance has sparked considerable interest in the relationship between bacteriophages and Pseudomonas aeruginosa ( Haddock et al., 2023 ), along with a renewed focus on phage therapy ( Fujiki et al., 2023 ). Mycolicibacterium neoaurum , a mycobacterium opportunistic infection, was previously mainly found in immunocompromised individuals ( Pang et al., 2022 ). However, there have been more reports of infections in cases that have undergone invasive medical examinations or surgeries ( Shapiro et al., 2023 ).…”

A narrative review of the controversy on the risk of mycobacterial infections with immune checkpoint inhibitor use: does Goldilocks have the answer?

“…As we posit later, it appears that either possibility (ICIs predisposing to mycobacterial infections or unmasking a pre-existing infection) as well as ICIs providing protection against mycobacterial infections may occur, depending on the baseline immune status of the host. In a patient with advanced hepatocellular carcinoma treated with anti-PD-1 antibody who developed multiple positive blood cultures for Mycobacterium neoaurum , the paramount risk factor was the presence of a chronic indwelling port catheter combined with the severe psoriasis that was exacerbated by the ICI ( 61 ). In other words, the prominent skin disease combined with a transcutaneous foreign object provided a likely portal of entry for the NTM invasion; i.e., there were significant pre-existing risk factors without necessarily incriminating the ICI.…”

Healthcare-Associated Infections Caused by Mycolicibacterium neoaurum

“…Of 21 isolates tested, all were susceptible to doxycycline, linezolid, and moxifloxacin according to the published report or Clinical and Laboratory Standards Institute broth microdilution interpretive criteria for RGM. Most isolates were susceptible to amikacin (17 of 18 isolates), cefoxitin (12 of 13), ciprofloxacin (15 of 16), imipenem (14 of 15), and meropenem (3 of 3) (Table) (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Isolates were less reliably susceptible to TMP/SMX (10 of 15 isolates) and clarithromycin (7 of 15).…”