Extensive Mycobacterium abscessus Pneumonia in an Immunocompetent Infant with No Underlying Lung Pathology

Abstract

Pulmonary infection due to Mycobacterium abscessus occurs in patients with cystic fibrosis, but rarely in immunocompetent children without underlying lung pathology. Treatment is complicated by frequent resistance to many antibiotics. We present a case report of a 4-month-old female infant with 2 months of cough, difficulty feeding, and failure to thrive, with extensive culture-confirmed M. abscessus pulmonary infection without identified immunodeficiency or underlying lung pathology following multidisciplinary evaluation. We describe our complete evaluation including immunodeficiency evaluation incorporating whole-exome sequencing, describe our antibiotic selection and treatment duration given complicated susceptibility pattern of the M. abscessus isolate, and review literature for nontuberculous mycobacterial pulmonary disease in immunocompetent children. A complete multidisciplinary evaluation for underlying lung disease and primary and acquired immunodeficiency should be undertaken in pediatric patients with M. abscessus pneumonia. Confirming macrolide susceptibility through erm(41) gene evaluation is clinically important for isolates with complicated susceptibility pattern.

Mycobacterium abscessus Pneumonia in an Immunonormal Infant

“…al. 16 also detail a previously healthy 4-month-old Hispanic female with a 2-month history of cough and failure to thrive with bilateral perihilar opacities and subcarinal lymphadenopathy. MABC was recovered from pleural fluid and gastric aspirate cultures.…”

“…We could find 3 reports of previously healthy pediatric patients presenting with MABC pneumonia. 9,15,16 Freeman et. al.…”

Omadacycline Potentiates Clarithromycin Activity Against Mycobacterium abscessus

“…Mab causes respiratory infections in patients whom are immunodeficient, have cystic fibrosis, are human immunodeficiency virus positive, have chronic obstructive pulmonary disease, or have bronchiectasis. It should be noted that pulmonary infection can also rarely occur in immunocompetent individuals with normal lung airways ( Ryan and Byrd, 2018 ; Alramadhan et al, 2021 ). There are several recommended treatments for Mab infections.…”