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DOI: 10.1055/s-0031-1297899
Mycobacterium genavense infection in a lung transplant recipient: case report
Aims: Atypical tuberculosis is a rare and feared complication with a high mortality rate among recipients of organ transplants. Mycobacterium genavense has been recognized in acquired immunodeficiency syndrome patients since 1990 with subsequent case reports in other immunocompromised host populations.
Case: We report a case of disseminated mycobacterium genavense infection in a 52-year-old female patient who underwent double lung transplantation for COPD Gold IV in July 2009. She presented to our unit with fever, obstipation, abdominal pain, and non-hemorrhagic diarrhea. CT scan of the chest and abdomen revealed diffuse wall thickening of the small bowel as well as multiple mesenteric and retrogastric lymphadenopathies. Colonoscopy showed normal findings besides a known diverticulosis of the sigma. Her blood work revealed relevant CMV viremia and i.v. ganciclovir was initiated. The patient, however, developed signs of acute abdomen with CT – proven free abdominal air, bipulmonary pneumonia with ground glass opacities, and pleural effusions.
The diagnosis of mycobacterium gavense infection was only established after histology of the biopsies of the colon, mesenteric lymph nodes, and lung revealed the presence of acid-fast rods, and stool cultures detected mycobacterium genavense. The patient initially responded well to tuberculostatic therapy consisting of ethambutol, rifabutin, and acithromycin, but later developed signs of hepatotoxicity and drug intolerance with aggravation of abdominal pain, motility disorder, and signs of secondary organ failure with respiratory insufficiency, hypercapnea, and renal insufficiency. Therefore, the regimen was changed to clarithromycin, rifaixim, and ciprofloxacin. The clinical status remains compromised and critical.
Discussion: Mycobacterium genavense infection is very difficult to diagnose due to its specific method of cultural propagation, and is mainly seen in patients with HIV. To our knowledge, this is the fourth case in a solid organ transplant candidate and the first in a lung transplant recipient. However, this type of infection needs to be considered when treating immunosuppressed patients presenting with weight loss, fever, and severe GI symptoms. Even with established diagnosis, treatment remains challenging.