Coexistent Gout and <i>Mycobacterium avium-intracellular</i><i>e</i> Arthritis in a Renal Transplant Recipient

Abstract

Infectious arthritis in renal transplant patients may be a commonly diagnosed condition with traditional bacterial organisms isolated. However, since nontuberculous mycobacteria are ubiquitous in the environment, immunocompromised individuals may suffer from infections with these organisms. Concomitant gout and Mycobacterium avium intracellulare septic arthritis is described for the first time in this clinical setting. Appropriate cultures should be performed even in the setting of crystal arthritis in posttransplant patients when clinically indicated.

Bursite fistulisée à Mycobacterium intracellulare chez un adulte immunocompétent

“…Des ostéo-myélites, des arthrites, des ténosynovites ont été décrites chez les malades immunodéprimés par le VIH ou lors d'un traitement par interféron ou d'un traitement immunosuppresseur [2][3][4][5]. Cependant, quelques rares observations ont rapporté des cas d'infections articulaires [6] et cutanées [7][8][9][10] à MAC chez des sujets immunocompétents.…”

Mycobacterium avium-intracellularecellulitis occurring with septic arthritis after joint injection: a case report

“…In our patient, the temporal relationship between the shoulder injections, the subsequent appearance of simultaneous bilateral MAI skin infections at the site of the injections, and the eventual occurrence of left shoulder MAI septic arthritis, provides strong circumstantial evidence for the causative role of joint injection in this patient. Cellulitis of the overlying skin has not been described in previous reports of MAI septic arthritis [6-10,12]. …”

“…It is not reported whether any of the 7 MAI septic arthritis patients in Kozin et al had been previously injected or aspirated [7]. Czachor et al reported a kidney transplant patient who developed MAI septic arthritis months after a diagnostic arthrocentesis for the diagnosis of gout [10]. In our patient, the temporal relationship between the shoulder injections, the subsequent appearance of simultaneous bilateral MAI skin infections at the site of the injections, and the eventual occurrence of left shoulder MAI septic arthritis, provides strong circumstantial evidence for the causative role of joint injection in this patient.…”

“…Cellulitis as a primary cutaneous manifestation is rare [4]. MAI septic arthritis has been described in immunocompetent patients [5-7], as well as in patients immunosuppressed by cancer, connective tissue disease, kidney transplant, and HIV [7-10]. MAI septic arthritis has been described after joint injection, however the causative role of the injection is difficult to ascertain [5,10].…”

DisseminatedMycobacterium avium-intracellularein a kidney transplant recipient

“…Clinical infection due to NTM in transplant recipients typically presents later in the transplant course, from 10 days to 269 months post‐transplant, with a mean latency of onset of 48 months (26). NTM species reported to cause infections in solid organ transplants include (8) M. kansasii , M. avium intracellulare (28), M. fortuitum (29), M. xenopi , M. haemophilum (30), M. marinum , M. chelonae (29, 31, 32), M. abscessus , M. gastri (33), M. scrofulaceum , and M. thermoresistibile (34). In contrast to infection with M. tuberculosis , fever, leukocytosis, night sweats, weight loss, and lymphadenopathy may not be prominent features of NTM infection in transplant recipients (8, 20, 35).…”