Prosthetic joint infection with Mycobacterium avium complex in a solid organ transplant recipient

Abstract

Prosthetic joint infection (PJI) occurs with significant morbidity and health care expenditure. Transplant recipients on immunosuppressive medications are at increased risk for infections caused by less common organisms at unusual sites. Here we report a case of isolated PJI with Mycobacterium avium complex (MAC) in an immunosuppressed failed kidney transplant recipient and review the literature on this unique infection. We discuss the likely pathogenesis of PJI with MAC including the role of biofilm formation by non-tuberculous mycobacteria. The possible role of cytokine milieu alteration by immunosuppressive therapy, particularly the reduction in interferon-gamma levels, as a predisposing factor for non-tuberculous mycobacterial infections in transplant recipients is explored. Lastly, we review the role of immune cell function assay in predicting the susceptibility to infection in our patient specifically and in solid organ transplant recipients in general.

Prosthetic Joint Infection

“…The knee was the most common site of infection, and seven of the eight patients were immunocompetent. In contrast, PJI due to the Mycobacterium avium complex has been reported primarily for immunocompromised patients with HIV/AIDS (234) or solid organ transplants ( [235][236][237]. The mechanism of infection is presumably hematogenous in M. avium complex PJI (234).…”

A rare case of disseminated Mycobacterium avium complex with colitis in a renal transplant recipient

“…Localized extrapulmonary MAC infections are uncommon, but have been reported in the literature. Specifically, in renal transplant recipients, cases have described MAC infections involving the lymphatics, spleen, liver, bone marrow, joints, and skin as well as the renal allograft itself . However, reports of intestinal MAC infection in renal transplant recipients are rare (Table ) …”

Mycobacterium avium complex disseminated infection in a kidney transplant recipient

“…Although this infection is well known in HIV patients (1), it remains unusual in KTRs (3,6). A careful literature review on PubMed, covering the last 30 years, excluding pediatric recipients and/or nonexhaustive case description revealed only 11 previous cases of MAC infections in adult KTRs, summarized in Table 1 (6)(7)(8)(9)(10)(11)(12)(13)(14). The 6 disseminated (6-10) and the 5 localized infections (6,(11)(12)(13)(14) occurred at a median time of 3 years (range 1-15) after transplantation.…”