Infect Chemother.  2017 Mar;49(1):78-83. 10.3947/ic.2017.49.1.78.

Mycobacterium kansasii Pneumonia with Mediastinal Lymphadenitis in a Patient with Acute Myeloid Leukemia: Successful Treatment to Stem Cell Transplantation

• Choi YG
• Cho SY
• Lee DG
• Yim E
• Joo H
• Ryu S
• Choi JK
• Kim HJ

• KMID: 2375104
• DOI: http://doi.org/10.3947/ic.2017.49.1.78

Abstract

Non-tuberculous mycobacterial (NTM) disease is a relatively rare cause of neutropenic fever in patients with hematologic malignancies. During the neutropenic period, performing invasive procedures for microbiological or pathological confirmation is difficult. In addition, the optimal treatment duration for NTM disease in patients with leukemia, especially prior to stem cell transplantation (SCT), has not been documented. Therefore, we report a case of pneumonia with necrotizing lymphadenitis caused by Mycobacterium kansasii diagnosed during chemotherapy being performed for acute myeloid leukemia. The radiologic findings were similar to those of invasive fungal pneumonia; however, a bronchoalveolar washing fluid culture confirmed that the pathogen was M. kansasii. After 70 days from starting NTM treatment, allogeneic SCT was performed without any complications. The patient fully recovered after 12 months of NTM treatment, and neither reactivation of M. kansasii infection nor related complications were reported.

Keyword

Mycobacterium kansasii; Lymphadenitis; Pneumonia; Leukemia, Myeloid, Acute; Stem cell transplantation

MeSH Terms

Drug Therapy
Fever
Hematologic Neoplasms
Humans
Leukemia
Leukemia, Myeloid, Acute*
Lymphadenitis*
Mycobacterium kansasii*
Mycobacterium*
Pneumonia*
Stem Cell Transplantation*
Stem Cells*

Figure

• 

  Figure 1 Radiologic findings of this case. (A) Low dose chest computed tomography (CT), performed on day 24 after induction chemotherapy, shows ill-defined, round consolidation (3.7 cm diameter, arrow) in left hilar area, with adjacent linear opacities and ground glass opacities. (B, C) Follow-up enhanced chest CT, performed before consolidation chemotherapy, shows increased size of consolidation (3.7 cm to 4.1 cm diameter, arrow) and newly noted necrotizing right paratracheal lymphadenopathy (4.5 cm diameter, arrowhead). (D, E) Enhanced chest CT after 6 months of treatment for nontuberculous mycobacteria shows decreased size of left hilar lesion (arrow) and right paratracheal lymphadenopathy (arrowhead).

• 

  Figure 2 Schematic presentation of the patient's clinical course. CIP, ciprofloxacin; FEP, cefepime; ISP, isepamicin; IPM, imipenem/cilastatin; CFP, cefoperazone; MEM, meropenem; PSC, posaconazole; AMB, amphotericin B, ITC, itraconazole; MIF, micafungin; INH, isoniazid; RIF, rifampicin; ETB, ethambutol; CT, computed tomography; CTx, chemotherapy; SCT, stem cell transplantation; Adm, admission; ANC, absolute neutrophil count.

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