Sonnenberg Jannik, Gabriels Gert, Olaru Ioana Diana, Mühl Sebastian, Fischer Julia, Pavenstädt Hermann, Trebicka Jonel, Peiffer Kai-Henrik, Tepasse Phil-Robin
Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany.
Department of Medicine D for General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, 48149 Münster, Germany.
Infect Dis Rep. 2025 Jun 1;17(3):60. doi: 10.3390/idr17030060.
BACKGROUND/OBJECTIVES: Nontuberculous mycobacteria (NTM) represent a heterogeneous group of pathogens with increasing global prevalence and significant geographical variation in species distribution. NTM infections, often affecting immunocompromised individuals, are difficult to diagnose due to nonspecific clinical presentations and laboratory findings. This case study presents a rare extrapulmonary NTM infection in a 73-year-old man, initially misdiagnosed as sarcoidosis, highlighting the diagnostic and therapeutic challenges posed by such infections.
The patient, a pigeon fancier, presented with recurrent fever and pancytopenia. Extensive diagnostics included blood cultures, bone marrow aspiration, and histopathology. Initial cultures and serological tests remained negative.
Bone marrow aspiration revealed epithelioid granulomas, initially leading to the provisional diagnosis of sarcoidosis. However, after six weeks, was isolated from mycobacterial blood cultures from bone marrow aspirant. Antimicrobial therapy with azithromycin, rifampicin, and ethambutol was initiated. Following the initiation of appropriate antimycobacterial therapy, the patient developed immune reconstitution inflammatory syndrome (IRIS), which was managed with supportive care. The patient's condition improved, and no further febrile episodes occurred post-treatment, marking the successful conclusion of NTM therapy.
This case underscores the diagnostic complexity of extrapulmonary NTM infections, particularly in immunocompromised patients. Misdiagnosis can delay appropriate treatment. , though rare, should be considered in patients with a fever of unknown origin, especially with a background of immunosuppression. Prompt mycobacterial testing and tailored antibiotic therapy are crucial to improving outcomes in NTM infections.
背景/目的：非结核分枝杆菌（NTM）是一组异质性病原体，在全球的流行率不断上升，且物种分布存在显著的地理差异。NTM感染通常影响免疫功能低下的个体，由于临床表现和实验室检查结果缺乏特异性，难以诊断。本病例研究报告了一名73岁男性罕见的肺外NTM感染，最初被误诊为结节病，突出了此类感染带来的诊断和治疗挑战。
该患者是一名信鸽爱好者，出现反复发热和全血细胞减少。广泛的诊断检查包括血培养、骨髓穿刺和组织病理学检查。初始培养和血清学检测均为阴性。
骨髓穿刺显示上皮样肉芽肿，最初导致结节病的初步诊断。然而，六周后，从骨髓穿刺物的分枝杆菌血培养中分离出[具体菌株未给出]。开始使用阿奇霉素、利福平和乙胺丁醇进行抗菌治疗。在开始适当的抗分枝杆菌治疗后，患者出现免疫重建炎症综合征（IRIS），通过支持治疗进行处理。患者病情改善，治疗后未再出现发热发作，标志着NTM治疗成功结束。
本病例强调了肺外NTM感染的诊断复杂性，特别是在免疫功能低下的患者中。误诊会延误适当的治疗。对于不明原因发热的患者，尤其是有免疫抑制背景的患者，应考虑[具体菌株未给出]感染，尽管这种情况罕见。及时进行分枝杆菌检测和定制抗生素治疗对于改善NTM感染的预后至关重要。
