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Disseminated Mycobacterium abscessus in a Lung Transplant Patient Manifesting as a Chest Wall Mass and Acute Renal Failure FREE TO VIEW

Ahmad Goodarzi, MD; Neeraj Sinha, MD; Soma Jyothula, MD; Babith Mankidy, MD; Thomas Kaleekal, MD; Victor Fainstein, MD
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Department of Medicine, Methodist Hospital, Houston, TX

Chest. 2014;146(4_MeetingAbstracts):347A. doi:10.1378/chest.1992368
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SESSION TITLE: Miscellaneous Case Report Posters III

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Atypical Mycobacterial disease is common in lung transplant, however only a few cases of Mycobacterium abscessus in lung transplant recipients have been described, mainly in cystic fibrosis.Disseminated M.abscessus is uncommon and difficult to treat.Here, We report a rare case of lung transplant patient with disseminated M.abscessus involving skin, blood and urinary tract.

CASE PRESENTATION: A 49-year-old woman with a history of idiopathic pulmonary fibrosis underwent left single lung transplant in February of 2013, admitted in February 2014 with nausea and weakness.She denied any respiratory symptoms.She had an episode of rejection in June 2013 requiring induction therapy.Physical examination was notable for a sub-cutaneous mass over right posterior chest wall, multiple skin leisions and breast implants with no tenderness.A computed tomographic scan of chest and abdomen revealed right lung with chronic interstitial lung disease and left lung free of infiltrates.Large soft tissue mass surrounds the insertion of the right 12th rib measuring 6.2x4.7cm with no bony destruction.Moderate right hydronephrosis was seen.CT guided needle biopsy of the chest wall mass revealed M.abcessus.Within 5 days,blood culture, skin leision and urine studies returned positive for M.abcessus.She was started on linezolid,moxifloxacin, imipenem and tigecycline.Bone marrow aspirate did not reveal Mycobacterium but had marked hypo-cellularity.Her outpatient medications included prednisone,tacrolimus,mycophenolate mofetil,prophylactic antibiotics(itraconazole,valganciclovir,azithromycin).Tacrolimus level on admission was within the therapeutic range.Immunosuppressive dose were decreased.Whole body Gallium CT image revealed diffuse cutaneous and lymph node uptake but no sign of implant involvement.Six weeks after admission, the patient has remained clinically stable and reports an improvement of her symptoms.

DISCUSSION: Disseminated M.abscessus with recovery from blood Culture is Extremely rare and suggests poor outcome.Rapid detection and early treatment is Essential.

CONCLUSIONS: Disseminated Mycobacterium abscessus is an emerging treatment challenge in lung transplant recipient.

Reference #1: Baldi S,Rapellino M,Ruffini E,Cavallo A,Mancuso M.Atypical mycobacteriosis in a lung transplant recipient.Eur Respir J.1997Apr;10(4):952-4

Reference #2: Chernenko SM,Humar A,Hutcheon M,Chow CW,Chaparro C,Keshavjee S,Singer LG.Mycobacterium abscessus infections in lung transplant recipients:the international experience.J Heart Lung Transplant.2006 Dec;25(12):1447-55

DISCLOSURE: The following authors have nothing to disclose: Ahmad Goodarzi, Neeraj Sinha, Soma Jyothula, Babith Mankidy, Thomas Kaleekal, Victor Fainstein

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