Mycobacterium kansasiiPneumonia with Mediastinal Lymphadenitis in a Patient with Acute Myeloid Leukemia: Successful Treatment to Stem Cell Transplantation

Abstract

Non-tuberculous mycobacterial (NTM) disease is a relatively rare cause of neutropenic fever in patients with hematologic malignancies. During the neutropenic period, performing invasive procedures for microbiological or pathological confirmation is difficult. In addition, the optimal treatment duration for NTM disease in patients with leukemia, especially prior to stem cell transplantation (SCT), has not been documented. Therefore, we report a case of pneumonia with necrotizing lymphadenitis caused by Mycobacterium kansasii diagnosed during chemotherapy being performed for acute myeloid leukemia. The radiologic findings were similar to those of invasive fungal pneumonia; however, a bronchoalveolar washing fluid culture confirmed that the pathogen was M. kansasii. After 70 days from starting NTM treatment, allogeneic SCT was performed without any complications. The patient fully recovered after 12 months of NTM treatment, and neither reactivation of M. kansasii infection nor related complications were reported.

Whole genome sequence of Mycobacterium kansasii isolates of the genotype 1 from Brazilian patients with pulmonary disease demonstrates considerable heterogeneity

“… 1 In the USA and South America M. kansasii is the second most isolated NTM after M. avium complex 2 , 3 while in Rio de Janeiro, it is the most frequent NTM to cause pulmonary disease. 4 Besides chronic bronchopulmonary disease, M. kansasii causes other clinical manifestations such as lymphadenitis 5 , skin and soft tissue infection 6 , tenosynovitis, arthritis, osteomyelitis and disseminated infection in patients co-infected with human immunodeficiency virus. 7 …”

Successful cord blood transplantation for myelodysplastic syndrome complicated by Mycobacterium kansasii pneumonia

“…NTM infection is rare as a fever cause in patients with febrile neutropenia. 1 However, if persistent, refractory fever is observed, it is important to actively carry out pathological and microbiological investigations.…”

“…6 However, there are few studies on optimal management methods for hematological diseases, and no information is available for before and after SCT. 1 Therefore, at present, the complication of NTM disease is a barrier to HSCT.…”

“…We have compiled known case reports of M kansasii infection associated with hematological disorders (Table 1). 1,2,[8][9][10][11][12][13][14] The cause of death was intestinal obstruction (case #4) or septic shock caused by non-M kansasii-causing bacteria (case #3), but all deaths were disseminated infections. The mortality rate of disseminated M kansasii infection was 60.3%, 9 which is a poor prognosis.…”

“…In addition, the optimal method to treat NTM disease in patients with hematological malignancy, especially before, during, and after hematopoietic stem cell transplantation (HSCT), is unclear. 1 There have been few reports of cases in which HSCT was successfully performed. We report a case of myelodysplastic syndrome (MDS) complicated by Mycobacterium kansasii (M kansasii) pneumonia diagnosed during chemotherapy.…”