Disseminated Mycobacterium abscessus subsp. massiliense infection in a Good’s syndrome patient negative for human immunodeficiency virus and anti-interferon-γ autoantibody: a case report

Abstract

Background: Good's syndrome (GS) is characterized by immunodeficiency, and can lead to severe infection, which is the most significant complication. Although Mycobacterium rarely causes infection in patients with GS, disseminated nontuberculous mycobacterial (NTM) infection frequently occurs in GS patients that are also positive for the human immunodeficiency virus (HIV) or anti-interferon (IFN)-γ autoantibodies. Here, we report a rare case of GS with NTM without HIV or IFN-γ autoantibodies. Case presentation: A 57-year-old Japanese male with GS and myasthenia gravis (treated with prednisolone and tacrolimus) was diagnosed with disseminated NTM infection caused by Mycobacterium abscessus subsp. massiliense. He presented with fever and back pain. Blood, lumbar tissue, urine, stool, and sputum cultures tested positive for M. abscessus. Bacteremia, spondylitis, intestinal lumber abscess, and lung infection were confirmed by bacteriological examination and diagnostic imaging; urinary and intestinal tract infections were suspected by bacteriological examination but not confirmed by imaging. Despite multidrug combination therapy, including azithromycin, imipenem/cilastatin, levofloxacin, minocycline, linezolid, and sitafloxacin, the patient ultimately died of the infection. The patient tested negative for HIV and anti-IFN-γ autoantibodies. Conclusions: Since myasthenia gravis symptoms interfere with therapy, patients with GS and their physicians should carefully consider the antibacterial treatment options against disseminated NTM.

Severe Pulmonary Mycobacterium abscessus Cases Due to Co-Infection with Other Microorganisms Well Treated by Clarithromycin and Sitafloxacin in Japan

“… 7 SFTX is a novel respiratory quinolone that is reportedly often used for patients with severe M. abscessus infection as an alternative and/or adjuvant to standard antibiotic regimens. 10 SFTX generally shows 2- to 16-fold higher antimicrobial effects compared with previous new quinolones, such as LVFX and ciprofloxacin. 7 In our cases, SFTX showed both microbiological susceptibility ( Table 1 ) and clinical efficiency in all patients, suggesting its usefulness as outpatient treatment for M. abscessus infection in combination with CAM.…”

“…massiliense . 10 He also had type 2 DM, and the correlation between an immunosuppressed status, including DM, and severe M. abscessus infection as an opportunistic infection was suggested. It was previously reported that non-classical monocytes from obesity-based DM and non-obese tuberculosis patients exhibit similar activation profiles (CD86/CD206/TLR-2 and TLR-4 expressions), and serum adiponectin levels increased similarly in tuberculosis and obesity-based DM patients.…”

SARS-CoV-2 T Cell Response in Severe and Fatal COVID-19 in Primary Antibody Deficiency Patients Without Specific Humoral Immunity

“…In IEI patients, type I IFN autoantibodies were reported for APS-1 patients ( 14 ). Although described previously ( 38 , 39 ), impact of type I IFN autoantibodies on the high case fatality rate in Good’s syndrome was never examined.…”

Thymoma with immunodeficiency, combined diffuse panbronchiolitis, and latent autoimmune diabetes in adults- case report and systematic review

“…In most cases where diabetes is reported, it is described as an underlying disease, but details on adjunctive tests and glycemic control are seldom provided. It appears that the onset of diabetes is independent of GS [ [48] , [49] , [50] ]. Latent autoimmune diabetes in adults (LADA) was first described by Tuomi et al, in 1993 [ 51 ] as having phenotypical characteristics similar to type 2 diabetes and immunological features akin to type 1 diabetes.…”