Invasive Ureaplasma Infection in Patients Receiving Rituximab and Other Humoral Immunodeficiencies—A Case Report and Review of the Literature

Abstract

Ureaplasma species are small, fastidious bacteria that frequently colonize the lower reproductive tract of asymptomatic hosts. These organisms have been well described to cause chorioamnionitis, neonatal infection, and urethritis, and to a lesser degree surgical site infection and infection in transplant recipients. Outside of these settings, invasive Ureaplasma infections are rare. We describe the case of a young woman receiving rituximab for multiple sclerosis who presented with fever and bilateral renal abscesses due to Ureaplasma spp., which was successfully treated with oral doxycycline. We searched the literature for cases of invasive Ureaplasma infection and found a patient population that predominates with humoral immunodeficiency, either congenital or iatrogenic. Diagnostic and therapeutic interventions are discussed.

Hyperammonemia syndrome due to Ureaplasma urealyticum in a kidney transplant recipient: A case of disseminated disease from a fluoroquinolone‐resistant isolate

“…infections include pyelonephritis, peritonitis, arthritis, abscesses, endovascular infections, pneumonia, and meningitis, with associated high mortality rates 2,4,6,8,11,22 . Notably, many infections have been described in hosts with hypogammaglobulinemia from administration of rituximab, 1,4,5,23 rather than transplant recipients. While the exact pathophysiology is unclear, hypogammaglobulinemic patients appear to be more susceptible to colonization of mucous membranes, especially of the urogenital tract, and progression to invasive disease 23 …”

“…infections, with or without microbiologic confirmation. 5,9,11 In one KT patient with HS and negative urine cultures, an occult urea cycle disorder was diagnosed, without additional microbiological testing. 16 Based on our case and emerging literature, we favor early molecular testing and specific media culture for Mycoplasma and Ureaplasma spp.…”

“…In immunocompromised (especially hypogammaglobulinemic) patients, they can cause severe disseminated infections. Due to the lack of cell wall, these bacteria are not visualized with gram stain and do not grow on conventional culture media 1‐5 . Ureaplasma spp.…”

Ureaplasma urealyticum disseminated multifocal abscesses in an immunocompromised adult patient: a case report

“…In immunodeficient patients it may cause a more severe disease. Current literature demonstrates only a few reports of U. urealyticum as the cause of disseminated disease in this population [8]. We present a case of nonresolving multifocal "culture-negative" abscesses in a hypogammaglobulinemic adult female due to U. urealyticum.…”

Immunsupprimert kvinne i 20-årene med magesmerter og utflod

“…Disseminert infeksjon kan sees hos immunkompromitterte. U. urealyticum har ikke blitt påvist som årsak til luftveisinfeksjoner hos voksne, men kan gi lungesykdom hos nyfødte (9).En lignende kasuistikk beskriver systemisk infeksjon med U. urealyticum hos en 27 år gammel kvinne under rituksimabbehandling for multippel sklerose(10). Pasienten hadde høy feber og magesmerter.…”