Cardiothoracic Surgery: Fellow Case Report Poster - Cardiac and Transplant Surgery |

Mycoplasma Hominis Infection After Lung Transplantation FREE TO VIEW

Shruti Gadre, MD; Christine Koval, MD; Kenneth McCurry, MD; Marie Budev, MD
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Cleveland Clinic Foundation, Cleveland, OH

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):38A. doi:10.1016/j.chest.2016.08.045
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SESSION TITLE: Fellow Case Report Poster - Cardiac and Transplant Surgery

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION:Mycoplasma hominis, a commensal organism of the urogenital tract, occasionally causes sternal wound infections and rarely pneumonia in immunocompromised patients.

CASE PRESENTATION: Seventy-two year old male with idiopathic pulmonary fibrosis underwent bilateral lung transplant with an uneventful intraoperative course. Post-operative prophylactic antibiotics included vancomycin and piperacillin-tazobactam for 3 days, trimethoprim-sulfamethoxazole, valganciclovir, itraconazole and inhaled amphotericin B. Immunosuppressive regimen included tacrolimus, prednisone and mycophenolate mofetil. He was extubated on post-operative day 1. On day 10, he developed dyspnea, purulent sputum and leukocytosis. Empiric antibiotics were restarted. Chest computed tomography revealed diffuse septal thickening and ground-glass opacities concerning for rejection. Sputum stain showed polymorphonuclear cells but no organisms. Empiric methylprednisolone (7.5mg/kg) was added for presumed acute cellular rejection followed by intravenous (IV) immunoglobulin, plasmapheresis and rituximab for presumed antibody mediated rejection. Bronchoalveolar lavage (BAL) and transbronchial biopsy revealed A0B0 rejection with diffuse alveolar damage (DAD), but no infection. On day 27, intubation was required for progressive respiratory failure. Open lung biopsy revealed acute lung injury (ALI) with organizing pneumonia and DAD. Stains for fungal, viral and bacterial (including acid fast bacilli) organisms were initially negative. Ten days after inoculation, tissue culture revealed M hominis on anaerobic media. He was treated with IV doxycycline for 3 weeks. Subsequent BAL culture was negative for M hominis and he was discharged on 2L supplemental oxygen.

DISCUSSION: We report a case of M hominis pneumonia causing ALI and DAD post-lung transplantation. There is only one such previously published report. This fastidious organism can go undetected in respiratory specimens due to overgrowth of other organisms and lack of anaerobic incubation. Treatment with doxycycline, clindamycin or both for 3-6 weeks results in improvement.

CONCLUSIONS:M hominis infection can cause significant morbidity post transplantation. The diagnosis is often delayed. The incidence is under recognized. Further studies are needed to determine prevention and treatment strategies.

Reference #1: Lyon G, et al. M hominis pneumonia complicating bilateral lung transplantation: case report and review of the literature. Chest 1997;112:1428-32

DISCLOSURE: The following authors have nothing to disclose: Shruti Gadre, Christine Koval, Kenneth McCurry, Marie Budev

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