Mycobacterium genavense infection in a patient with long‐standing chronic lymphocytic leukaemia

Abstract

. Krebs T, Zimmerli S, Bodmer T & Lämmle B (Central Hematology Laboratory, Inselspital, University Hospital of Bern; Institute of Medical Microbiology, University of Bern, Bern, Switzerland). Mycobacterium genavense infection in a patient with long‐standing chronic lymphocytic leukaemia (Case Report). J Intern Med 2000; 248: 343–348. We describe the first case of disseminated infection with Mycobacterium genavense in an HIV‐seronegative patient with a chronic haematological disorder. Our patient, an 80‐year‐old woman, had been under long‐term treatment with chlorambucil (partially in combination with prednisone) for B‐cell chronic lymphocytic leukaemia (B‐CLL). When she developed general fatigue and progressive anaemia, as well as progressive lymphadenopathy and splenomegaly, bone marrow biopsy revealed granulomas with acid‐fast bacilli, and cultures of both bone marrow and blood grew M. genavense. The patient’s CD4+ cell count was approximately 100 µL–1. Treatment with clarithromycin, ethambutol and rifabutin resulted in improvement of anaemia and general health as well as in regression of lymphadenopathy and splenomegaly.

Early Diagnosis of DisseminatedMycobacterium genavenseInfection

“…genavense causes up to 12.8% of all nontuberculous mycobacteria infections in AIDS patients; these infections are clinically similar to those caused by the M. avium complex (1,6 M. genavense infections occur only rarely in persons other than AIDS patients (as in the present case), but they always occur in immunocompromised persons (7,8). To date, only 1 case of disseminated infection has been reported in a solid-organ (kidney) transplant recipient; the diagnosis was made by molecular identifi cation in isolates from blood and marrow cultures.…”

Relapsing Mycobacterium Genavense Infection as a Cause of Late Death in a Lung Transplant Recipient: Case Report and Review of the Literature

“…Disseminated infection with Mycobacterium genavense has been described mostly in patients with advanced human immunodeficiency virus (HIV) infection. 1 In HIV-negative patients, about 10 reports of disseminated M. genavense infection have been published in immunocompromised hosts, [2][3][4][5][6][7][8][9][10] including only 4 cases have occurred in transplant recipients in the last 5 years. 2,[6][7][8] We report a case in a lung transplant recipient, with a fatal outcome more than 3 years after a diagnosis owing to late-onset recurrence of the infection.…”

Pneumocystis carinii pneumonia in chronic lymphocytic leukaemia

“…We could only find one other patient suffering from CLL with such low CD4 numbers; this patient developed a mycobacterial infection. 11 As in our patient this patient had longstanding disease that lasted approximately 10 years and was treated with chlorambucil and intermittently with prednisone. Therefore longstanding CLL might lead to depletion of CD4 T-cells and clinicians might therefore consider a prophylactic antibiotic in these patients.…”