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Case Reports: Rare disease
Disseminated Mycobacterium genavense infection in a patient with a history of sarcoidosis
  1. Emil Vilstrup1,
  2. Victor Næstholt Dahl2,3,
  3. Andreas Fløe4 and
  4. Kristine Bruun Degn4
  1. 1Department of Internal Medicine Viborg, Viborg Regional Hospital, Viborg, Denmark
  2. 2Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
  3. 3Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Aarhus C, Denmark
  4. 4Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus N, Denmark
  1. Correspondence to Dr Victor Næstholt Dahl; victordahl{at}gmail.com

Abstract

We present a case of Mycobacterium genavense infection in a man in his 60s with a history of sarcoidosis, treated for 24 years with systemic corticosteroids and later methotrexate as monotherapy. He presented with low grade fever, dyspnoea and right-sided thoracic pain and was admitted due to a treatment-refractory infection. After a prolonged period of symptoms and diagnostics, acid-fast bacilli were demonstrated in pleural fluid and PCR revealed M. genavense. The patient was treated with intravenous amikacin, peroral azithromycin, rifampicin and ethambutol for a total of 18 months, with a good clinical and radiological treatment response. Infection with M. genavense is rare in HIV-negative immunocompromised hosts. Diagnosing and treating mycobacterial infections, especially for more rare species, remains a challenge as clinical evidence is sparse. Nonetheless, the disease-causing infection must be considered in symptomatic and immunocompromised patients.

  • Respiratory medicine
  • TB and other respiratory infections
  • Immunology
  • Infectious diseases
  • Medical management

http://dx.doi.org/10.1136/bcr-2023-254792

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    Footnotes

    • Contributors EV and VND contributed to conceptualisation. EV and VND contributed to writing–original draft preparation. EV, VND, AF and KBD contributed to writing–review & editing. EV, VND, AF and KBD contributed to patient management. All authors critically revised the article for important intellectual content and approved the 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests VND and AF participate on the advisory board for Nordicinfu Care Denmark who distributes ARIKAYCE (amikacin liposome inhalation suspension) for Insmed. All other authors had no conflict of interests to declare.

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