Department of Internal Medicine, Lankenau Medical Center, Wynnewood, PA, USA.
Division of Infectious Diseases, Lankenau Medical Center, Wynnewood, PA, USA.
Int J Mycobacteriol. 2021 Jan-Mar;10(1):82-84. doi: 10.4103/ijmy.ijmy_242_20.
Mycobacterium chimaera has been described in postoperative cardiovascular procedures in patients after an outbreak of contaminated 3T heater-cooler units. Immune reconstitution inflammatory syndrome (IRIS) has been mostly reported in immunocompromised patients, especially HIV after starting therapy. Our case is a 52-year-old immunocompetent male who was diagnosed with M. chimaera mediastinitis a year after Type A dissection repair and was started on quadruple antimicrobial therapy. He clinically improved but 8 months into therapy he presented with a declining kidney function, pancytopenia, and hypercalcemia which after bone marrow and kidney biopsies were attributed to IRIS. Our patient's diagnosis spared him subsequent surgery. IRIS during the treatment of nontuberculous mycobacteria must be suspected even in immunocompetent patients as reaching the diagnosis is very helpful in preventing additional diagnostic and therapeutic measures.
分枝杆菌 chimaera 已在受污染的 3T 热交换器单元爆发后的术后心血管手术中被描述。免疫重建炎症综合征 (IRIS) 主要在免疫功能低下的患者中报告，尤其是开始治疗后的 HIV。我们的病例是一名 52 岁免疫功能正常的男性，他在 A 型夹层修复后一年被诊断为 chimaera 分枝杆菌纵隔炎，并开始接受四联抗菌治疗。他的临床状况有所改善，但在治疗 8 个月后，他出现肾功能下降、全血细胞减少和高钙血症，骨髓和肾脏活检后归因于 IRIS。我们的患者因诊断而避免了后续手术。在治疗非结核分枝杆菌时，即使在免疫功能正常的患者中也应怀疑存在 IRIS，因为诊断非常有助于防止额外的诊断和治疗措施。
