Disseminated Mycobacterium chelonae infection in kidney transplant patients

BMJ Case Rep. 2024 Sep 18;17(9):e260095. doi: 10.1136/bcr-2024-260095.

Abstract

Mycobacterium chelonae (M. chelonae) is a member of the rapidly growing non-tuberous mycobacteria and can cause disseminated tissue infection, particularly, in the limbs. We reviewed medical records of two kidney transplant patients. We describe their background disease and transplantation details, with the use of immunosuppressive medication. We also discuss the presentation of M. chelonae infection and treatment. Both patients received deceased brain-dead donor kidney transplants for end-stage kidney disease. Both developed cutaneous manifestations of M. chelonae, progressing to disseminated infections. Case 1 was on low-dose prednisolone (2 mg) and tacrolimus, whereas, case 2 received varying doses of prednisolone (5-40 mg) and sirolimus. Antibiotics advised by infectious disease specialists were initiated within a month of skin lesion appearance. Effective treatment involved a combination of antibiotics such as clarithromycin, azithromycin, linezolid and tigecycline. These cases underline the efficacy of clarithromycin and azithromycin as long-term antibiotic treatment, with linezolid and tigecycline for management of acute dissemination.

Keywords: Infectious diseases; Renal system; Renal transplantation.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-Bacterial Agents* / therapeutic use
  • Clarithromycin / therapeutic use
  • Female
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / surgery
  • Kidney Failure, Chronic / therapy
  • Kidney Transplantation* / adverse effects
  • Male
  • Middle Aged
  • Mycobacterium Infections, Nontuberculous* / diagnosis
  • Mycobacterium Infections, Nontuberculous* / drug therapy
  • Mycobacterium Infections, Nontuberculous* / microbiology
  • Mycobacterium chelonae*
  • Tigecycline / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Immunosuppressive Agents
  • Clarithromycin
  • Tigecycline