Disseminated Mycobacterium avium complex infection mimicking malignancy in a patient with anti-IFN-γ autoantibodies: a case report

Yeh, Yun-Kai; Ding, Jing-Ya; Ku, Cheng‐Lung; Chen, Wei-Chih

doi:10.1186/s12879-019-4564-4

Cited by 9 publications

(7 citation statements)

References 16 publications

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“…Anti-tumour necrosis factor-α agents (infliximab, etanercept and adalimumab) used to treat several diseases such as rheumatoid arthritis, psoriatic arthritis and inflammatory bowel disease can predispose to both TB and NTM diseases 125 . A good response to rituximab in disseminated MAC patients with interferon-gamma autoantibodies has also been reported 126 127 .…”

Section: Clinical Manifestationsmentioning

confidence: 81%

Epidemiology, diagnosis & treatment of non-tuberculous mycobacterial diseases

2020

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Non-tuberculous mycobacteria (NTM) are ubiquitously present in the environment, but NTM diseases occur infrequently. NTM are generally considered to be less virulent than Mycobacterium tuberculosis , however, these organisms can cause diseases in both immunocompromised and immunocompetent hosts. As compared to tuberculosis, person-to-person transmission does not occur except with M. abscessus NTM species among cystic fibrosis patients. Lung is the most commonly involved organ, and the NTM-pulmonary disease (NTM-PD) occurs frequently in patients with pre-existing lung disease. NTM may also present as localized disease involving extrapulmonary sites such as lymph nodes, skin and soft tissues and rarely bones. Disseminated NTM disease is rare and occurs in individuals with congenital or acquired immune defects such as HIV/AIDS. Rapid molecular tests are now available for confirmation of NTM diagnosis at species and subspecies level. Drug susceptibility testing (DST) is not routinely done except in non-responsive disease due to slowly growing mycobacteria ( M. avium complex, M. kansasii ) or infection due to rapidly growing mycobacteria, especially M. abscessus . While the decision to treat the patients with NTM-PD is made carefully, the treatment is given for 12 months after sputum culture conversion. Additional measures include pulmonary rehabilitation and correction of malnutrition. Treatment response in NTM-PD is variable and depends on isolated NTM species and severity of the underlying PD. Surgery is reserved for patients with localized disease with good pulmonary functions. Future research should focus on the development and validation of non-culture-based rapid diagnostic tests for early diagnosis and discovery of newer drugs with greater efficacy and lesser toxicity than the available ones.

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Section: Clinical Manifestationsmentioning

confidence: 81%

Epidemiology, diagnosis & treatment of non-tuberculous mycobacterial diseases

2020

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“…1,2,6 Bone marrow or blood, lung, bladder, liver, and biliary tree are likewise the sites of infection. 6,[24][25][26] The clinical manifestations, locations of the infected sites, and causative agents are likely to differ across ethnicities. Rapidly growing mycobacteria (RGM), such as M. abscessus, were the most common NTM species isolated from Thai, Chinese and Filipino patients, whereas M. avium complex (MAC) was predominant among Japanese and non-Asian patients.…”

Section: Anti-ifn-c Aabs and Pathologymentioning

confidence: 99%

“…The most common drugs used for the treatment of NTM are a regimen combining rifampin, ethambutol, clarithromycin, linezolid, and amikacin. 4,19,26,39,[51][52][53] Anti-fungal medicines that include amphotericin B, itraconazole, and fluconazole have been used for the treatment of Talaromyces marneffei and Cryptococcus spp. 54,55 Nevertheless, the disease can be refractory and fatal, despite appropriate and aggressive antimicrobial treatment.…”

Section: Clinical Management Of Anti-ifn-c Aabsmentioning

confidence: 99%

“…Many studies showed that disseminated NTM in patients with anti-IFN-γ autoantibodies can mimic malignancy, cancer, and synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome. 26,28,29 Therefore, differential diagnosis should be handled delicately. Most reported cases of patients with anti-IFN-γ AAbs are older adults.…”

Section: Anti-ifn-γ Aabs and Pathologymentioning

confidence: 99%

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Minireview: Insights into anti-interferon-γ autoantibodies

Chawansuntati

Rattanathammethee

Wipasa

2021

Exp Biol Med (Maywood)

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The association between the presence of anti-interferon-γ autoantibodies and the onset of immunodeficiency with intracellular infections has been clearly established. No standard regimen to control the production of these pathogenic autoantibodies, apart from antimicrobial therapy to eliminate infections, contributes to the medical burden of this syndrome, which sometimes has a fatal outcome. In this review, we summarize the findings on anti-interferon-γ autoantibodies to facilitate further research and to provide guidance for treatment strategies.

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“…Mainly, species of the M. avium complex (MAC, formerly called MAI-M. avium-intracellulare-complex) have been involved in disseminated infections in severely immunocompromised patients. Other NTM (as for example M. genavense), have also been described [1,6,7]. In disseminated disease, NTM can be cultured from different specimens such as citrate or EDTA blood, organ biopsies, sputum, bronchoalveolar lavage fluid and others.…”

Section: Introductionmentioning

confidence: 99%

Disseminated disease due to non-tuberculous mycobacteria in HIV positive patients: A retrospective case control study

et al. 2021

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Introduction Disseminated infection due to non-tuberculous mycobacteria has been a major factor of mortality and comorbidity in HIV patients. Until 2018, U.S. American guidelines have recommended antimycobacterial prophylaxis in patients with low CD4 cell counts, a practice that has not been adopted in Europe. This study aimed at examining the impact of disseminated NTM disease on clinical outcome in German HIV patients with a severe immunodeficiency. Materials and methods In this retrospective case control study, HIV patients with disseminated NTM disease were identified by retrospective chart review and matched by their CD4 cell counts to HIV patients without NTM infection in a 1:1 alocation. Primary endpoints were mortality and time to first rehospitalisation. In addition, other opportunistic diseases, as well as antimycobacterial and antiretroviral treatments were examined. Results Between 2006 and 2016, we identified 37 HIV patients with disseminated NTM disease. Most of them were suffering from infections due to M. avium complex (n = 31, 77.5%). Time to event analysis showed a non-significant trend to higher mortality in patients with disseminated NTM disease (p = 0.24). Rehospitalisation took place significantly earlier in patients with disseminated NTM infections (median 40.5 days vs. 109 days, p<0.0001). Conclusion In this retrospective case control study, we could demonstrate that mortality is not significantly higher in HIV patients with disseminated NTM disease in the ART era, but that they require specialised medical attention in the first months following discharge.

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Disseminated Mycobacterium avium complex infection mimicking malignancy in a patient with anti-IFN-γ autoantibodies: a case report

Cited by 9 publications

References 16 publications

Epidemiology, diagnosis & treatment of non-tuberculous mycobacterial diseases

Epidemiology, diagnosis & treatment of non-tuberculous mycobacterial diseases

Minireview: Insights into anti-interferon-γ autoantibodies

Disseminated disease due to non-tuberculous mycobacteria in HIV positive patients: A retrospective case control study

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