Disseminated Mycobacterium avium complex infection in a woman with anti-interferon-γ autoantibodies

• Published in: IDCases 2021-01, Vol.26, p.e01300, Article e01300
• Main Authors: Dahl, Victor Naestholt, Nielsen, Bibi Uhre, Wejse, Christian Morberg, Marquart, Hanne Vibeke, Bay, Jakob Thaning, von Stemann, Jakob Hjorth, Lillebaek, Troels, Andersen, Aase Bengaard
• Format: Article
• Language: English
• Subjects: Anti-IFN-γ autoantibodies; Case Report; Immunodeficiency; Mycobacterium avium complex; Nontuberculous mycobacteria
• ISSN: 2214-2509; 2214-2509
• DOI: 10.1016/j.idcr.2021.e01300

•Disseminated MAC infections should always prompt investigations for immunodeficiencies.•Anti-IFN-γ autoantibodies may lead to severe treatment refractory mycobacterial infection.•Clinical studies investigating immunomodulating therapy of patients with anti-IFN-γ autoantibodies are lacking Defects in the interleukin-12/interferon-gamma (IFN-γ) pathway and anti-IFN-γ antibodies have been associated with severe nontuberculous mycobacteria (NTM) infections. Consequently, disseminated NTM infections should prompt investigations for immunodeficiency. Herein, we report a case of a treatment refractory and ultimately disseminated and fatal Mycobacterium avium complex infection in a 71-year-old woman of Thai origin. Simultaneously, she had recurrent Salmonella kentucky cultured from stool samples and chronic perianal HSV-2 lesions. Late in the course of disease, anti–IFN-γ autoantibodies were demonstrated. Clinical studies investigating immunomodulating therapy and treatment among patients with anti-IFN-γ autoantibodies are lacking and, in this case, treatment seemed of a more palliative nature.