COVID-19 Coinfection with Mycobacterium abscessus in a Patient with Multiple Myeloma

Abstract

Background. Coronavirus disease (COVID-19) is a worldwide pandemic causing multiple fatalities and morbidities worldwide. We report a case of severe pneumonia causing acute respiratory distress syndrome due to a coinfection with SARS-CoV-2 and Mycobacterium abscessus in an elderly patient with multiple myeloma in Florida, USA. Case Presentation. An 84-year-old male with a medical history significant for multiple myeloma not in remission was sent to the emergency department to rule out COVID-19 infection prior to continuing his chemotherapy sessions. At presentation, he had nonspecific mild symptoms and an unremarkable physical examination. He had significant blood test findings including serum lactate dehydrogenase 373 U/L, high sensitive C-reactive protein 17.40 mg/l, and ferritin 415 ng/ml. Xpert-SARS-CoV-2 was positive. Chest radiograph revealed patchy areas of interstitial infiltrates in mid to lower lung zones. During his hospitalization course, his oxygenation deteriorated, requiring mechanical intubation. Repeat chest radiograph showed worsening bilateral infiltrates. He was started on broad-spectrum antibiotics and eventually weaned off mechanical intubation and extubated. On the 11th day of admission, he was found to be bradycardic and in shock, and he was reintubated. His labs showed worsening inflammatory markers along with kidney dysfunction to the point of requiring renal replacement therapy. He received both convalescent plasma and remdesivir for treatment of COVID-19 pneumonia. Eventually, repeat blood cultures came back positive for the growth of acid-fast beaded bacilli. While awaiting final culture and sensitivity reports, his antibiotics were upgraded to cover possible nocardia infection. Repeat blood and sputum cultures resulted in growth of AFB bacilli Mycobacterium abscessus 1 week after. Conclusions. This case report highlights the importance of keeping a broad differential and considering multiple coinfections, including atypical ones during this COVID-19 pandemic, such as the one that was discussed above, Mycobacterium abscessus, in order to provide goal-directed therapy.

Comparative survival of environmental and clinical Mycobacterium abscessus isolates in a variety of diverse host cells

“…Considering the SARS‐CoV‐2 (COVID‐19) pandemic, there is a consequential need to better understand the virulence of respiratory microbes. Already, co‐infection with MABS and SARS‐CoV‐2 has been reported in an elderly patient with multiple myeloma (Rodriguez et al, 2021 ). As a shapeshifter of the mycobacterial world, MABS displays a spectrum of morphologies and variations in their capacity to form pellicles or cord, but it's not known whether these morphotypes contribute to virulence and pathogenicity (Ryan & Byrd, 2018 ).…”

COVID-19 Virus Infection in Three Patients With Hypogammaglobulinemia

“…There is no strong evidence to indicate that COVID-19 pathogenesis is significantly different in patients with hypogammaglobulinemia or multiple myeloma. There is one report of coinfection with COVID-19 and Mycobacterium abscessus in a patient with multiple myeloma who was eventually treated with convalescent plasma and remdesevir; however, there is no evidence to indicate that coinfection is more common in these patients [ 17 ]. While a recent report details a patient in Brazil with concern for COVID-19 reinfection, it is difficult to tell if cancer patients are at increased risk for reinfection and if reinfection can be confirmed with our testing [ 18 ].…”

Use of convalescent plasma inCOVID‐19 patients with immunosuppression

“…Many treatments of hematologic malignancies, such as the cornerstone of treatment (anti‐CD‐20 monoclonal antibodies), may lead to prolonged B‐cell depletion and impaired immune responses 43,44 . From 32 case reports 45–76 and 11 case series, 27,44,77–85 we identified 150 COVID‐19 patients with hematological malignancies treated with convalescent plasma. Among these 150 patients, the mortality rate was 20% (30 of 150 patients), 37 patients demonstrated rapid clinical improvement after convalescent plasma transfusion, and the average time between convalescent plasma transfusion and hospital discharge was 27 days.…”