Taylor Jennifer L, Palmer Scott M
Division of Pulmonary/Critical Care Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
J Heart Lung Transplant. 2006 Aug;25(8):985-8. doi: 10.1016/j.healun.2006.04.003. Epub 2006 Jul 11.
Mycobacterial infections are increasingly recognized in cystic fibrosis (CF) patients before transplant; however, knowledge about the clinical significance or spectrum of infections observed with mycobacterial infections in lung transplant recipients is still evolving. Herein, we report a case of infection with Mycobacterium abscessus in a CF lung transplant recipient. Despite aggressive treatment before and peri-operatively with anti-mycobacterial therapy, the patient developed skin and soft tissue infection of the incision and of bilateral breast implants, eventually leading to disseminated pulmonary infection and death. This report highlights the potential for M abscessus to cause post-transplant disease in CF patients undergoing lung transplant, despite peri-operative anti-mycobacterial therapy. Thus, pre-transplant colonization with M abscessus should be viewed as a strong relative, if not absolute, contraindication to lung transplantation. The combination of the virulent pre-transplant pathogen M abscessus and foreign bodies in the chest likely acted synergistically to contribute to the unfortunate outcome in this patient.
分枝杆菌感染在肺移植前的囊性纤维化（CF）患者中越来越受到重视；然而，关于肺移植受者中分枝杆菌感染的临床意义或感染谱的认识仍在不断发展。在此，我们报告一例CF肺移植受者发生脓肿分枝杆菌感染的病例。尽管在术前和围手术期积极进行抗分枝杆菌治疗，但患者仍出现切口及双侧乳房植入物的皮肤和软组织感染，最终导致播散性肺部感染并死亡。本报告强调了脓肿分枝杆菌在接受肺移植的CF患者中导致移植后疾病的可能性，尽管围手术期进行了抗分枝杆菌治疗。因此，移植前脓肿分枝杆菌定植应被视为肺移植的一个强有力的相对禁忌证，即使不是绝对禁忌证。移植前的强毒病原体脓肿分枝杆菌与胸部异物的结合可能协同作用，导致了该患者的不幸结局。
