1369. Clinical Manifestations, Treatment, and Outcome of Nontuberculous Mycobacteria (NTM) Infection in Adult-Onset Immunodeficiency Associated with Anti-interferon-gamma Autoantibodies in King Chulalongkorn Memorial Hospital

Abstract

BackgroundThere is an increase of anti-interferon-γ autoantibodies syndromes because it is now well recognized, especially in the Southeast Asia region. One of the clinical features is an infection caused by nontuberculous mycobacteria (NTM). NTM infection in patients with anti-interferon-γ autoantibodies is usually severe, recurrent, and disseminated. In this study, we describe the clinical characteristics, treatment, and outcome of NTM infection in patients with anti-interferon-γ autoantibodiesMethodsA retrospective cohort study was conducted at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand, during 2010–2018. Demographic, clinical, and microbiological data were collected and analyzed.ResultsA total of 45 patients were enrolled in this study. Twenty-nine patients were males, and 16 patients were females. The most common clinical manifestations were fever with lymphadenopathy. The median age of the study population was 55 years. The most common organ that was infected was the lymph node (91%). Sweet’s syndrome (68%) was the most common immunological skin reaction. The proportion of infection caused by rapid-growing NTM was more prevalent than slow-growing NTM. The most common NTM was Mycobacterium abscessus (44.4%). The most common co-pathogen identified in this study was Salmonella (37.8%). All patients had positive antibody to interferon-γin the serum which was detected by enzyme-linked immunosorbent assay (ELISA) and mean optical density was 3.28. Fifty-one percent of the patients received long-term antimycobacterial therapy due to chronic active infection, new infections and relapsed. 22.2% of the patients developed a new infection during treatment. However, 28.9% of patients were completely cured of the infection during the follow-up period. The overall mortality rate was 11.1%ConclusionAdult-onset immunodeficiency with anti-interferon-γ autoantibodies is a unique clinical syndrome that has been recognized in Thailand. Treatment of this disorder requires a long duration of the combination of antimycobacterial agents. Sweet’s syndrome is an indicator of recurrence/relapse of NTM infection during the clinical course. Long-term monitoring and immunomodulator are essential for the management of this condition.Disclosures All authors: No reported disclosures.