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Case Reports Journal Article Epublish 1 citation

PubMed: 40559191 DOI: 10.3390/idr17030060

The Underestimated Threat-Mycobacterium Genavense Infection: A Case Report.

Infect Dis Rep 17(3)

Authors: Jannik Sonnenberg, Gert Gabriels, Ioana Diana Olaru, Sebastian Mühl, Julia Fischer, Hermann Pavenstädt, Jonel Trebicka, Kai-Henrik Peiffer, Phil-Robin Tepasse

Affiliations

  • Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany.
  • Department of Medicine D for General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, 48149 Münster, Germany.
  • Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany.
  • Gerhard Domagk Institute of Pathology, University Hospital Münster, 48149 Münster, Germany.

Abstract

BACKGROUND/OBJECTIVES

Nontuberculous mycobacteria (NTM) represent a heterogeneous group of pathogens with increasing global prevalence and significant geographical variation in species distribution. NTM infections, often affecting immunocompromised individuals, are difficult to diagnose due to nonspecific clinical presentations and laboratory findings. This case study presents a rare extrapulmonary NTM infection in a 73-year-old man, initially misdiagnosed as sarcoidosis, highlighting the diagnostic and therapeutic challenges posed by such infections.

METHODS

The patient, a pigeon fancier, presented with recurrent fever and pancytopenia. Extensive diagnostics included blood cultures, bone marrow aspiration, and histopathology. Initial cultures and serological tests remained negative.

RESULTS

Bone marrow aspiration revealed epithelioid granulomas, initially leading to the provisional diagnosis of sarcoidosis. However, after six weeks, M. genavense was isolated from mycobacterial blood cultures from bone marrow aspirant. Antimicrobial therapy with azithromycin, rifampicin, and ethambutol was initiated. Following the initiation of appropriate antimycobacterial therapy, the patient developed immune reconstitution inflammatory syndrome (IRIS), which was managed with supportive care. The patient's condition improved, and no further febrile episodes occurred post-treatment, marking the successful conclusion of NTM therapy.

CONCLUSIONS

This case underscores the diagnostic complexity of extrapulmonary NTM infections, particularly in immunocompromised patients. Misdiagnosis can delay appropriate treatment. M. genavense, though rare, should be considered in patients with a fever of unknown origin, especially with a background of immunosuppression. Prompt mycobacterial testing and tailored antibiotic therapy are crucial to improving outcomes in NTM infections.

MeSH

Bone Marrow, Blood, Mycobacterium, Sarcoidosis, Fever Of Unknown Origin, Pancytopenia, Diagnosis, Therapeutics, Blood Culture, Infections, Nontuberculous Mycobacteria