Abstract
BackgroundNontuberculous mycobacterium (NTM) infection in a patient in an immunosuppressed state caused by increased use of immunosuppressive or biological agents is a serious clinical problem. Mycobacterium avium complex is the most common involved pathogen, followed by Mycobacterium abscessus (MABSC), while Mycobacterium kansasii is not a major concern. The rate of infection rate in lung transplant recipients is reported to range from 1.5–22.4%.Case presentationWe report here four cases of NTM pulmonary infection and disease among 63 patients who underwent lung or heart-lung transplantation at our hospital. Those four occurred following living-donor transplantation in two patients, one with pulmonary arterial hypertension and one with bronchiectasia, and deceased donor lung transplantation in two patients, lymphangioleiomyomatosis and interstitial pneumonia, respectively. NTM was not detected in any of the patients prior to transplantation. The involved pathogens were Mycobacterium gordonae in one, MAC in one, and MABSC in two of these patients, which were isolated from broncho-alveolar lavage (BAL) in two and sputum in two. The one case of MAC and two of MABSC were symptomatic with consolidation shown in chest CT images indicating possible pneumonia, while the one with M. gordonae had no symptoms and was detected by surveillance BAL. Onset time from detection of NTM was greater than 3 years in the three with MABSC and M. gordonae and less than 3 years in the one with MAC. Each patient required a decrease in immunosuppressive agents according to their condition, while antibiotics therapy was performed in the three who were symptomatic. Sputum culture findings became negative after several months and were maintained thereafter in all.ConclusionAn NTM infection leading to pulmonary disease can occur at any time following lung transplantation. Treatment should be considered depending on the involved pathogens, individual status, and disease severity.
Highlights
Nontuberculous mycobacterium (NTM) infection in a patient in an immunosuppressed state caused by increased use of immunosuppressive or biological agents is a serious clinical problem
The number of patients with pulmonary nontuberculous mycobacterium (NTM) is increasing worldwide [1, 2], with NTM infection in patients in an immunosuppressed state caused by increased use of immunosuppressive or biological agents a serious clinical problem
Floto et al reported that an NTM infection occurring in patients with cystic fibrosis can be problematic, as that can influence the indication for lung transplantation [13]
Summary
The number of patients with pulmonary nontuberculous mycobacterium (NTM) is increasing worldwide [1, 2], with NTM infection in patients in an immunosuppressed state caused by increased use of immunosuppressive or biological agents a serious clinical problem. Case 1 An 11-year-old boy with pulmonary arterial hypertension underwent living-donor lung transplantation, with tacrolimus, mycophenolate mofetil (MMF), and prednisolone (PSL) given as immunosuppressive agents. Case 2 A 38-year-old female with bronchial ectasia underwent living-donor lung transplantation, with ciclosporin, MMF, and PSL given as immunosuppressive agents. Following administrations of tazobactam/piperacillin and azithromycin (AZM), as well as a decrease in ciclosporin from 120 to 50 mg for 1 month, the sputum cultures became negative. Case 3 A 39-year-old female with lymphangioleiomyomatosis underwent single deceased donor lung transplantation, with ciclosporin, MMF, and PSL given as immunosuppressive agents. Amikacin, and AZM for 4 months, sputum culture findings became negative.
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