Disseminated Mycobacterium abscessus subspecies massiliense infection and subsequent prosthetic joint infection in a hemodialysis patient: A case report |
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| Affiliation: | 1. Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, Japan;2. Department of Medical Technology, Okayama University Graduate School of Health Sciences, Okayama, Japan;3. Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan;1. Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, 260-8673, Japan;2. Department of Pharmacology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El-Sheikh, 33516, Egypt;1. Laboratory of Microbiology, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Japan;2. Dept. of Food Microbiology and Molecular Biology, National Institute of Nutrition, Viet Nam;1. Department of Gastroenterology, Fiona Stanley Hospital, Murdoch, Australia;3. Department of Gastroenterology, St John of God Hospital, Murdoch, Australia |
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| Abstract: | A 74-year-old man with diabetic nephropathy undergoing dialysis after total knee arthroplasty presented to our hospital with dyspnea and abnormal behavior such as wearing his pants on his head. The patient was in shock with ventricular tachycardia. Urine and blood cultures showed MAM with sterile pyuria. We administered amikacin and imipenem cilastatin, but repeated cultures were persistently positive. Although we initially chose not to administer azithromycin because of a higher risk of fatal arrhythmia, we had no choice but to administer azithromycin because of treatment failure. Upon close monitoring, we observed no arrhythmia, and the blood cultures became negative. The patient was discharged on day 106 without any symptoms. However, 2 months after discontinuation of antibiotics, he was readmitted and diagnosed with prosthetic joint infection due to MAM. He could not undergo total knee arthroplasty resection because of his low tolerance to surgery. We re-administered same antibiotics, and repeated draining and cleaning of his left knee for several weeks. The inflammation in the knee joint gradually improved, and the patient was discharged while treatment with azithromycin and amikacin was continued. After being discharged, the patient did not experience recurrent disease for at least 6 months.Our case suggests that MAM can cause sterile pyuria and infection in a patient with diabetic nephropathy. The macrolide agent is a key drug for MAM infection, and repeated joint lavage in addition to administering antibiotics may be an alternative treatment for prosthetic joint infection in patients with intolerance to surgery. |
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| Keywords: | Sterile pyuria Diabetic nephropathy Prosthetic joint infection Blood cultures AMK" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" amikacin AZM" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" azithromycin DST" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" drug susceptibility testing Ga" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" gallium HIV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" human immunodeficiency virus IgA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" immunoglobulin A IgG" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" immunoglobulin G IgM" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" immunoglobulin M IPM/CS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" imipenem cilastatin MAC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0130" }," $$" :[{" #name" :" text" ," $$" :[{" #name" :" italic" ," _" :" Mycobacterium avium" },{" #name" :" __text__" ," _" :" complex MABC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0140" }," $$" :[{" #name" :" text" ," $$" :[{" #name" :" italic" ," _" :" Mycobacterium abscessus" },{" #name" :" __text__" ," _" :" complex MAM" },{" #name" :" keyword" ," $" :{" id" :" kwrd0150" }," $$" :[{" #name" :" text" ," $$" :[{" #name" :" italic" ," _" :" Mycobacterium abscessus" },{" #name" :" __text__" ," _" :" subspecies " },{" #name" :" italic" ," _" :" massiliense MIC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0160" }," $$" :[{" #name" :" text" ," _" :" minimal inhibitory concentration NTM" },{" #name" :" keyword" ," $" :{" id" :" kwrd0170" }," $$" :[{" #name" :" text" ," _" :" non-tuberculosis mycobacteria PCR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0180" }," $$" :[{" #name" :" text" ," _" :" Polymerase chain reaction PET-CT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0190" }," $$" :[{" #name" :" text" ," _" :" positron emission tomography-computed tomography PIPC/TAZ" },{" #name" :" keyword" ," $" :{" id" :" kwrd0200" }," $$" :[{" #name" :" text" ," _" :" piperacillin/tazobactam PJI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0210" }," $$" :[{" #name" :" text" ," _" :" prosthetic joint infection RGM" },{" #name" :" keyword" ," $" :{" id" :" kwrd0220" }," $$" :[{" #name" :" text" ," _" :" rapidly growing mycobacterial TKA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0230" }," $$" :[{" #name" :" text" ," _" :" total knee arthroplasty VT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0240" }," $$" :[{" #name" :" text" ," _" :" ventricular tachycardia |
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