Abstract
Infections may constitute a serious complication in patients with chronic lymphocytic leukemia (CLL). New treatment agents including obinutuzumab and ibrutinib have improved the progression-free survival in CLL, and data suggest a similar overall infection risk and a limited risk of opportunistic infections when compared to standard chemo-immunotherapy. Nevertheless, cases of opportunistic infections including non-tuberculous mycobacterial (NTM) in CLL patients have recently been published. We present a case of a 74-year old man with extensive prior CLL treatment history, including most recently obinutuzumab. He developed an abscess of the psoas muscle and inguinal lymphadenopathy. An inguinal node biopsy specimen showed infection with Mycobacterium avium, confirmed by broad-spectrum mycobacterial PCR, M. avium-specific PCR, and mycobacterial culture. This case and our literature review suggest that physicians should be aware of opportunistic infections in patients with CLL. Diagnostic differentiation from CLL disease progression, Richter’s transformation to aggressive lymphoma, and secondary malignancy relies on histological and appropriate microbiological studies from biopsy material of affected organs. Infection prophylaxis in CLL should be considered, including vaccinations and intravenous immune globulin replacement.
Highlights
Infection with Mycobacterium avium complex (MAC) is a rare complication in patients with chronic lymphocytic leukemia (CLL), with four previous cases reported in the literature [1,2,3,4]
This case and our literature review suggest that physicians should be aware of opportunistic infections in patients with CLL
In addition to MAC, other non-tuberculous mycobacterial (NTM) infections have been recorded in CLL patients, including infections with M. chelonae [10,11,12], M. marinum [13,14], M. szulgai [15], M. fortuitum [16] and M. genavense [17] (Table 2)
Summary
Infection with Mycobacterium avium complex (MAC) is a rare complication in patients with chronic lymphocytic leukemia (CLL), with four previous cases reported in the literature [1,2,3,4]. We present a patient with CLL who developed a psoas abscess due to M. avium, after having received extensive previous CLL therapies and five months after first receiving treatment with obinutuzumab. This case and our literature review suggest that physicians should be aware of opportunistic infections in patients with CLL. Accurate diagnosis of progressive lymphadenopathy in CLL requires appropriate biopsy material to be analysed microbiologically and histologically
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