414: Disseminated Ureaplasma Urealyticum Infection and Life-Threatening Hyperammonemia With Rituximab Use

Refractory Bilateral Tubo-Ovarian Abscesses in a Patient with Iatrogenic Hypogammaglobulinemia

“…The literature on Ureaplasma infections signals a strong relationship between humoral immunodeficiency and invasive spread [13,23]. Our case is similar to three prior reports of severe U. urealyticum infection in women <30 years old on chronic rituximab therapy for the management of MS (2 cases) [9,13] and granulomatosis with polyangiitis (GPA) (1 case) [10]. Kvalvik et al (2020) published a case almost identical to ours: a woman in her early twenties with MS, presenting with fever and progressive abdominal pain, was found to have bilateral TOAs [9].…”

“…Kvalvik et al (2020) published a case almost identical to ours: a woman in her early twenties with MS, presenting with fever and progressive abdominal pain, was found to have bilateral TOAs [9]. U. urealyticum was identified as the causative agent in all case studies through urine culture [13], a PCR of respiratory and urinary samples [10], and pus analysis [9], and was responsive to treatment with doxycycline. Based on our collective findings, we and the authors of the aforementioned studies [9,13] suggest a revision of current guidelines [6] to recommend testing for Mollicute infections in hypogammaglobulinemic patients with PID.…”

“…Nonetheless, it is important to consider how the risk-benefit tradeoff for testing and treatment shifts in the setting of immunosuppression. There have been multiple case studies of U. urealyticum infections in immunocompromised children and adults in the setting of hematologic malignancy [8], autoimmune disease [9,10], and organ transplant [11,12]. The majority of these cases are reported in patients with congenital or iatrogenic hypogammaglobulinemia [13].…”