To Induce Immune Reconstitution Inflammatory Syndrome or Suppress It: The Spectrum of Mycobacterium genavense in the Antiretroviral Era

Abstract

Mycobacterium genavense is a challenging opportunistic pathogen to diagnose and manage in HIV patients. Persistent immune suppression or protracted immune reconstitution inflammatory syndrome can lead to complicated clinical courses. We describe three cases of Mycobacterium genavense in HIV patients representing the spectrum between disease burden and strength of immune response.

Mycobacterium genavense mesenteritis responsible for refractory chylous ascites despite multiple immunomodulatory therapies in a patient with AIDS

“…Numerous immunomodulatory therapies as steroid-sparing agents have been used to control M. genavense mesenteritis-IRIS manifestations. A benefit of TNF-α inhibitors in the treatment of steroid-dependent M. genavense - and M. tuberculosis -IRIS has been reported [4,6]. In our patient, TNF-α inhibitor therapy at a high dose (10 mg/kg monthly), in association with colchicine and corticosteroids led to resolution of refractory ascites for several months.…”

“…M. genavense mesenteritis mostly becomes manifest during immune reconstitution inflammatory syndrome (IRIS) [1,3–5]. We describe the failure of various immunomodulatory therapies over 7 years of follow-up, for steroid-dependent M. genavense mesenteritis IRIS responsible for refractory chylous ascites in a patient with AIDS.…”

Successful rescue TNF-α blocking for Mycobacterium genavense – Related immune reconstitution inflammatory syndrome: A case report

“…The use of anti-TNF-α in NTM IRIS is less described. Two case reports have been published concerning successful treatment with infliximab in steroid-dependent IRIS due to disseminated M. genavense disease, with a favorable clinical and radiological outcome for both patients [ 21 , 22 ]. To qualify, a case recently reported by Laurent et al described a late-onset (after seven years) fatal multi-refractory IRIS related to M. genavense in an HIV patient with ascites and portal thrombosis despite an increased dose of infliximab (10 mg/kg/month) and concomitant treatment with corticosteroids and colchicine [ 23 ].…”

Host-directed immunotherapy of viral and bacterial infections: past, present and future

“…Endotypes, which are defined as distinct molecular profiles based on metabolism, epigenetics, transcription or immune function, have been proposed to guide the application of personalized immunotherapies 162 . However, specific endotypes remain to be defined for most infections, even for those with ostensibly similar clinical phenotypes 163 . A particular challenge exists for diseases of global public health impact such as TB and now COVID-19, for which individualized therapies are considered impractical.…”