Disseminated Mycobacterium abscessus subsp. massiliense infection in a Good’s syndrome patient negative for human immunodeficiency virus and anti-interferon-γ autoantibody: a case report

• Published in: BMC infectious diseases 2020-06, Vol.20 (1), p.1-431, Article 431
• Main Authors: Imoto, Waki, Yamada, Koichi, Hajika, Yuriko, Okamoto, Kousuke, Myodo, Yuka, Niki, Makoto, Kuwabara, Gaku, Yamairi, Kazushi, Shibata, Wataru, Yoshii, Naoko, Nakaie, Kiyotaka, Yoshizawa, Kazutaka, Namikawa, Hiroki, Watanabe, Tetsuya, Asai, Kazuhisa, Moro, Hiroshi, Kaneko, Yukihiro, Kawaguchi, Tomoya, Itoh, Yoshiaki, Kakeya, Hiroshi
• Format: Article
• Language: English
• Subjects: Anti-interferon-gamma autoantibody; Antibiotics; Autoantibodies; Azithromycin; Back pain; Bacteremia; Bacterial infections; Biopsy; Bronchopulmonary infection; Case Report; Case reports; Diagnostic systems; Disseminated; Fever; Good’s syndrome; HIV; Hospitalization; Human immunodeficiency virus; Imipenem; Infections; Infectious diseases; Interferon; Intestine; Laboratories; Levofloxacin; Linezolid; Lumber; Medical imaging; Minocycline; Myasthenia; Myasthenia gravis; Mycobacterium abscessus; Neuromuscular junctions; Nontuberculous mycobacterial infection; Patients; Physicians; Prednisolone; RNA polymerase; Spondylitis; Sputum; Tacrolimus; Tuberculosis; Viruses; γ-Interferon
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-020-05136-x

Background Good’s syndrome (GS) is characterized by immunodeficiency, and can lead to severe infection, which is the most significant complication. Although Mycobacterium rarely causes infection in patients with GS, disseminated nontuberculous mycobacterial (NTM) infection frequently occurs in GS patients that are also positive for the human immunodeficiency virus (HIV) or anti-interferon (IFN)-γ autoantibodies. Here, we report a rare case of GS with NTM without HIV or IFN-γ autoantibodies. Case presentation A 57-year-old Japanese male with GS and myasthenia gravis (treated with prednisolone and tacrolimus) was diagnosed with disseminated NTM infection caused by Mycobacterium abscessus subsp. massiliense. He presented with fever and back pain. Blood, lumbar tissue, urine, stool, and sputum cultures tested positive for M. abscessus. Bacteremia, spondylitis, intestinal lumber abscess, and lung infection were confirmed by bacteriological examination and diagnostic imaging; urinary and intestinal tract infections were suspected by bacteriological examination but not confirmed by imaging. Despite multidrug combination therapy, including azithromycin, imipenem/cilastatin, levofloxacin, minocycline, linezolid, and sitafloxacin, the patient ultimately died of the infection. The patient tested negative for HIV and anti-IFN-γ autoantibodies. Conclusions Since myasthenia gravis symptoms interfere with therapy, patients with GS and their physicians should carefully consider the antibacterial treatment options against disseminated NTM.