Relapsing Mycobacterium Genavense Infection as a Cause of Late Death in a Lung Transplant Recipient: Case Report and Review of the Literature

Abstract

Mycobacterium genavense is recognized as a lifethreatening pathogen in severely immunocompromised patients, mostly in those with advanced human immunodeficiency virus infection. We report a case of M. genavense infection in a lung-transplant recipient with late-onset death occurring from disseminated infection. In human immunodeficiency virus-negative patients, there exist only about 10 reports of disseminated M. genavense infection in immunocompromised hosts; and to our knowledge, this is a first reported case of M. genavense infection after a lung transplant. Diagnosis of M. genavense was obtained only with nucleic acid-based identification technique, as frequently observed in a few cases of human immunodeficiency virus-negative patients. A striking feature was the recurrence of this infection in our patient after a seemingly infection-free period of 3 years. Because M. genavense infection can be life-threatening, clinicians must be aware of the frequent requirement for nucleic-acid-based identification for its diagnosis.

Mycobacterium genavense infection in a solid organ recipient: a diagnostic and therapeutic challenge

“…The incidence of M. genavense infection in the Swiss HIV Cohort Study (1990-1992, before introduction of HAART) was found to represent 12.8% of disseminated NTM infections (21). This cohort also demonstrated that the clinical presentation consists of fever (80- SOT recipients with M. genavense infection reported in the literature, 6 patients (the majority) underwent kidney transplantation (4)(5)(6)(9)(10)(11), our currently reported 1 patient had a combined kidney-heart transplantation, 1 patient had a combined kidneypancreas transplantation (12), 2 patients had liver transplantation (9, 10), 1 patient had a lung transplantation (13), and 3 patients had heart transplantation (8,11,14). All patients presented with disseminated disease, and 6 of them died despite treatment.…”

“…M. genavense infections occur rarely in SOT recipients. Of the 14 immunocompromised HIV‐negative SOT recipients with M. genavense infection reported in the literature, 6 patients (the majority) underwent kidney transplantation , our currently reported 1 patient had a combined kidney–heart transplantation, 1 patient had a combined kidney–pancreas transplantation , 2 patients had liver transplantation , 1 patient had a lung transplantation , and 3 patients had heart transplantation . All patients presented with disseminated disease, and 6 of them died despite treatment.…”

“…All patients presented with disseminated disease, and 6 of them died despite treatment. Table 1 shows all reported cases of M. genavense infection in HIV-negative SOT patients (4)(5)(6)(8)(9)(10)(11)(12)(13)(14).…”

Nontuberculous Mycobacteria Infections in Immunosuppressed Hosts

“…However, it is clear that there are differences in virulence and immune response to different species, evidenced by species variations in the predominant site of infection and the fact that several species, including M. haemophilum and M. genavense , cause infection almost exclusively in immunocompromised patients. 18-20 The various settings of immunosuppression that are related to NTM infection are summarized in Table 1 and described in more detail in their respective sections.…”

A Rare and Challenging Case of Pulmonary Mycobacterium genavense in an Immunocompetent Adult

“…Since then, it had been reported to cause life threatening infection in severely immunodeficient patients with human immunodeficiency virus (HIV) infection [1]. In HIVnegative patients, disseminated M. genavense infection had also been reported, however, these patients were usually in immunocompromised state, such as those with long-standing chronic lymphocytic leukaemia [2], those undergoing immunosuppressive therapy [3] and solid organ transplant recipients [4]. To the best of our knowledge, there had only been 2 cases of M. genavense infection reported in healthy individuals [5,6].…”