Rituximab as Successful Adjunct Treatment in a Patient With Disseminated Nontuberculous Mycobacterial Infection Due to Acquired Anti-Interferon-  Autoantibody

Czaja, Christopher A.; Merkel, Patricia; Chan, Edward D.; Lenz, Laurel; Wolf, Molly L.; Alam, Rafeul; Frankel, Stephen K.; Fischer, Aryeh; Gogate, Shaila; Pérez-Vélez, Carlos M.; Knight, Vijaya

doi:10.1093/cid/cit809

Cited by 79 publications

(55 citation statements)

References 12 publications

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“…43,44 It should be noted that rituximab has been used as an adjunct to successfully treat otherwise recalcitrant chronic NTM infections in patients with auto-antibody states involving IFN-gamma. 45,46 …”

Section: Immunosuppressive Therapies For Immune-mediated Inflammatorymentioning

confidence: 99%

Nontuberculous Mycobacteria Infections in Immunosuppressed Hosts

Henkle

Winthrop

2015

Clinics in Chest Medicine

258

205

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Synopsis Diseases and therapies that reduce cell-mediated immunity increase the risk of nontuberculous mycobacterial (NTM) disease. Historically acquired immunodeficiency virus (AIDS), cancer, and hematologic and solid organ transplants have been associated with NTM disease. More recently, immunosuppressive drugs including anti-tumor necrosis factor (anti-TNF) biologics have been associated with NTM disease in population-based studies. Extrapulmonary NTM disease, including disseminated and skin and catheter-related disease, is more common in immunosuppressed compared to immunocompetent patients. Mycobacterium avium complex remains the most common cause of NTM infection of all sites, but rapid growers including M. abscessus, M. chelonae, and M. fortuitum play an important role in skin and catheter-related infections. With the exception of prophylaxis for AIDS patients with very low CD4+ counts, the prevention of NTM remains difficult. Management is complicated and involves restoring immune function and removing catheters in addition to treatment with species-specific antibiotic treatment per current ATS/IDSA guidelines.

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Section: Immunosuppressive Therapies For Immune-mediated Inflammatorymentioning

confidence: 99%

Nontuberculous Mycobacteria Infections in Immunosuppressed Hosts

Henkle

Winthrop

2015

Clinics in Chest Medicine

258

205

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“…Administration of rituximab (average of 8–12 doses over 12 months) in four patients with severe, treatment refractory, disseminated NTM with high‐titre IFN‐γ autoantibodies was associated with objective improvement and remission or cure of infection . This, together with other studies, forms part of an accumulating body of evidence supporting the use of immunomodulatory therapies, including plasmapheresis and exogenous IFN infusions, in the management of patients with high‐titre IFN‐γ autoantibodies …”

Section: Standard Investigations Showed Negative Results For Immunodementioning

confidence: 58%

Disseminated Mycobacterium haemophilum skeletal disease in a patient with interferon‐gamma deficiency

Otome

O’Reilly

2015

Internal Medicine Journal

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Disseminated non-tuberculous mycobacterial (NTM) infection is rare in immunocompetent adults. Anti-interferon-gamma (IFN-γ) autoantibodies have recently been associated with NTM infections, particularly in patients of Asian ethnicity. We describe a case of disseminated Mycobacterium haemophilum skeletal infection due to anti IFN-γ autoantibodies in a 71-year-old Cambodian man. He responded to a combination of anti-mycobacterial antibiotics without requirement for immunomodulator therapy. Testing for acquired IFN-γ deficiency due to IFN-γ autoantibodies should be considered when standard tests for immunodeficiency are negative in patients with unusual or severe opportunistic infections, including NTM.

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“…Although the mechanism of antibody production and the acquisition of neutralizing capacity remain unknown, some reports have speculated on the association between the antibody and NTM infection. Two groups from the USA reported the utility of rituximab against disseminated NTM in patients with anti-IFN-g autoantibodies [4,5]. The subjects went into remission along with reduction in the concentration or neutralizing capacity of anti-IFNg autoantibodies as a consequence of rituximab administration.…”

Section: Discussionmentioning

confidence: 99%

“…In most cases, the causative agents of disseminated NTM include Mycobacterium avium complex (MAC) and rapid-growing mycobacteria [1e3]. The concentration or neutralizing capacity of anti-IFN-g autoantibodies was reduced after the initiation of anti-mycobacterial agents and rituximab in a few cases [4,5]. A case of disseminated Mycobacterium gordonae and Mycobacterium mantenii in a patient with anti-IFN-g autoantibodies is described.…”

Section: Introductionmentioning

confidence: 99%