Heart transplantation across preformed donor-specific antibody barriers using a perioperative desensitization protocol

Abstract

Non-tuberculous mycobacteria are becoming increasingly important pathogens among transplant recipients. We report a case of disseminated Mycobacterium haemophilum infection in a heart transplant recipient, manifesting as cellulitis, subcutaneous nodules, septic arthritis, and pneumonitis. Our case illustrates diverse challenges in the identification and treatment of this pathogen, such as its unique culture requirements and variable antimicrobial susceptibilities. Heightened clinical suspicion is necessary to establish a timely diagnosis so that optimal treatment can be administered.

Atypical Focal Osteomyelitis as Initial Manifestation of AIDS

“…Till year 2000, only 90 cases of Mycobacterium haemophilum infections were reported across the world [3]. Clinical symptoms essentially manifest as chronic nodular or ulcerative skin lesions, but rare cases of bacteraemia, pneumopathies, septic arthritis, and osteomyelitis have been reported [1, 4, 5]. …”

“…Mycobacterium haemophilum is thus the most frequent pathogen causing osteomyelitis in AIDS patients [7–9]. More than 30 cases were reported with a majority of patients with advanced AIDS disease or chronically immunosuppressed [1, 4, 10–12]. …”

“…The first intention treatment is thus a tritherapy combination of Ciprofloxacin, Clarithromycin, and Rifabutin for 9–18 months. In cases of irreversible immunosuppression, patients should continue this tritherapy for life [1, 3, 4, 10, 17–19]. …”

Mycobacterium Haemophilum

“…2,3 Common complications of this infection include skin granulomas, arthritis, osteomyelitis, and pneumonitis. 3 We are unaware of previous reports of M haemophilum endophthalmitis, and could find no reference to it in a computerized search utilizing PubMed. The indolent course followed by a rapid deterioration is similar to the clinical course reported in endophthalmitis caused by other nontuberculous mycobacteria (NTM).…”

Chronic Cutaneous Mycobacterium haemophilum Infection Acquired from Coral Injury

“…By 2001, the organism had been reported in 90 cases of infection worldwide [1,2,7,9], 87 of which were in immunocompromised patients. Laboratory records may be useful in elucidating the epidemiology of M. haemophilum.…”