Disseminated Mycobacterium Scrofulaceum Infection in a Patient with Anti-Interferon-γ Autoantibodies

Abstract

Mycobacterium scrofulaceum is an environmental mycobacterial species rarely reported to cause disseminated infection in adults. We report the case of a disseminated M. scrofulaceum infection in a 55-year-old nonhuman immunodeficiency virus-infected Thai man with anti-interferon-γ autoantibodies. The clinical signs of the infection improved after the induction regimen with amikacin, rifampicin, ethambutol, and clarithromycin, followed by the consolidation regimen with ethambutol, clarithromycin, and trimethoprim/sulfamethoxazole. Our review of previous reported cases of this infection indicates its association with immune deficiency, complex treatment, and a high rate of unfavorable outcomes.

Anticytokine Autoantibodies in Infectious Diseases: A Practical Overview

“…Five patients achieved remission—of whom two could discontinue antimycobacterial treatment—two relapsed and one died [ 19 ]. Fourth and last, in case reports or small case series, the effect of B cell depleting therapy with rituximab has been described in patients with anti-IFNγ auto-antibodies whose infections were refractory to antibiotic therapy, all with good clinical effect and little side effects and resulting in sustained remission [ 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. Comparably, four Asian women with treatment-refractory disseminated NTM infections that were also not responsive to additional immunomodulatory therapy with plasmapheresis (1 patient) or IFNγ supplementation (3 patients) responded to treatment with rituximab.…”