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Recurrent disseminated Mycobacterium avium in a female patient from Thailand with anti-interferon-gamma autoantibodies: dilemma on treatment approach
  1. Kristen Zeitler1,
  2. Jolan Walter2,
  3. Fatima Khan2 and
  4. Chakrapol Sriaroon3
  1. 1Pharmacy, Tampa General Hospital, Tampa, Florida, USA
  2. 2Pediatric Allergy/Immunology, University of South Florida College of Medicine, Tampa, Florida, USA
  3. 3Pulmonary/Critical Care, University of South Florida College of Medicine, Tampa, Florida, USA
  1. Correspondence to Dr Chakrapol Sriaroon; csriaro{at}health.usf.edu

Abstract

Anti-interferon-gamma (IFN-γ) autoantibodies has been recognised as an adult-onset immunodeficiency in the past decade in people who originate from Southeast Asia. These patients are susceptible to particular opportunistic infections, especially non-tuberculous mycobacteria (NTM). We present the case of a woman whom originally came from Thailand with disseminated Mycobacterium avium complex infection (pleural, pericardium, bloodstream and lung parenchymal involvement). Her infection continued to progress while receiving proper antibiotic treatment. Once high titre neutralising anti-IFN-γ autoantibodies were detected, rituximab was added as adjunctive treatment. The patient had remarkable clinical improvement against persistence of anti-IFN-γ autoantibodies. Although her lung disease has improved, the patient continues on triple therapy for NTM. The kinetics of anti-IFN-γ autoantibodies in the context of clinical progression, indication and length for rituximab and triple therapy is discussed in view of the current literature.

  • immunology
  • infectious diseases

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Footnotes

  • Contributors KZ: contributed to planning of manuscript, conception and design for writing, acquisition of data, interpretation of data, writing of manuscript and editing/approval of final version. JW: contributed to planning of manuscript, conception and design for writing, acquisition of data, interpretation of data, writing of manuscript and editing/approval of final version. FK: contributed to planning of manuscript, conception and design for writing, acquisition of data, interpretation of data, writing of manuscript and editing/approval of final version. CS: contributed to planning of manuscript, conception and design for writing, acquisition of data, interpretation of data, writing of manuscript and editing/approval of final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.