Lung cavitation due to Mycobacterium xenopi in a renal transplant recipient

Abstract

Mycobacterium xenopi is an unusual pathogen and few such cases have been reported in the literature. We report the case of a patient with a sirolimus-based immunosuppressive regimen, who developed lung cavitation. M. xenopi was isolated from the sputum. The patient was treated initially with rifampicin, isoniazid, and pyrazinamide; levofloxacin was added to the treatment regimen after M. xenopi was demonstrated. A possible relationship between sirolimus and M. xenopi infection has been postulated, probably due to the combination of pulmonary toxicity and cellular immunosuppression of rapamycin.

Nontuberculous mycobacteria infection in solid organ transplant recipients

“…Symptoms include a chronic cough, dyspnea and sputum production; hemoptysis has been reported less frequently, especially in the case of cavitation. Pulmonary findings may range from fibrocavitary disease (undistinguishable from TB, and characterized by infiltrates, cavities and scar formation on chest Xray), single or multiple pulmonary nodules, lung consolidation and bronchiectasis [26,27]. In addition, over onehalf of subjects with pulmonary disease exhibited considerable extrapulmonary involvement including skin, soft tissue, or joints.…”

Nontuberculous mycobacterial pulmonary infection in renal transplant recipients

“…Few cases of NTM pulmonary infection in KTR have been reported so far, so that the clinical presentation, diagnosis, and management of NTM lung disease in this population remain ill defined. In Table 2, we compare our case with 14 previous observations of NTM lung disease in KTR (4–12). Three mycobacterial species arise as being mainly responsible for NTM pulmonary infections in KTR: Mycobacterium kansasii, Mycobacterium xenopi , and MAC.…”

“…Three mycobacterial species arise as being mainly responsible for NTM pulmonary infections in KTR: Mycobacterium kansasii, Mycobacterium xenopi , and MAC. Whereas M. xenopi seems to cause isolated lung disease (7–9), M. kansasii and MAC can cause disseminated disease with lung involvement (4, 5, 10, 11). The mean time from transplantation to onset of the NTM lung disease was 33.4 months (2–120 months), indicating that NTM lung disease is, like other NTM infections, a late post‐transplant infectious complication (1).…”

Nontuberculous mycobacterial infections after transplantation: a diversity of pathogens and clinical syndromes

“…Like the other members of the NTM group, M. xenopi is an environmental organism that is found in water and soil, tap‐water systems, showerheads, and hot‐water tanks. The most common clinical presentation of M. xenopi infection is pulmonary disease, which can have a cavitating process (19, 20), as in the case reported. Interstitial pneumonitis and solitary pulmonary nodules may also occur (21), and dissemination to cause endophthalmitis has been described (22).…”

“…The current issue of Transplant Infectious Disease reminds clinicians of this diversity in the etiology, clinical syndromes, treatment, and outcomes of human diseases caused by NTM species. In the first article, Martin‐Penagos et al (19) describe a man who presented with productive cough, fever, and lung cavitation 8 years after undergoing deceased donor kidney transplantation. Using 16S ribosomal RNA sequencing, the offending pathogen was identified as Mycobacterium xenopi , an obligate thermophile that grows optimally at 45°C.…”