open access

Vol 76, No 2 (2008)
CASE REPORTS
Published online: 2008-04-28
Submitted: 2013-02-22
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Mycobacterial infection caused by Mycobacterium avium in allogenic bone marrow transplant recipient with concomittant bronchiolitis obliterans as a manifestation of graft versus host disease - case report and review of the literature

Agnieszka Buraczewska, Anna Kempisty, Jan Kuś, Małgorzata Bartosiewicz
Pneumonol Alergol Pol 2008;76(2):111-117.

open access

Vol 76, No 2 (2008)
CASE REPORTS
Published online: 2008-04-28
Submitted: 2013-02-22

Abstract

Patients after organ transplantations are at risk for mycobacteriosis development.
Frequency of the mycobacterial infection after bone marrow transplantation (BMT) is not as high as one could expect. It ranges from 0.4 to 4.9%.
We present a case of a female patient after allogenic BMT as a treatment of chronic myelogenous leucaemia, with bronchiolitis obliterans as a symptom of graft versus host disease (GvHD), treated with corticosteroids and infected with Mycobacterium avium.
She was admitted to the hospital with dyspnoea, cough with large amount of sputum production and subfebrile status. She had partial respiratory insufficiency and obturative disturbances of respiration (FEV1 0.67 l i.e. 22% of normal) with decline of VC (2.23 l i.e. 64% of normal). The high-resolution computed tomography (HRCT) revealed multifocal infiltrations and bronchiectases in the upper and middle pulmonary fields, which were absent in the previous HRCT taken 3 years earlier. In the bronchial secretion acid-fast bacilli were found by smear and culture. The isolate was classified as Mycobacterium avium complex (MAC) by high performance liquid chromatography (HPLC). The patient was treated with clarithromycin, ciprofloxacin, isoniazide (INH), ethambutol (EMB), amikacin, but M. avium was still present in the sputum after 3 months. Treatment was continued in her parent hospital, where after a few months her sputum became negative for M. avium. But she died over a year later from progressive respiratory insufficiency in the course of bronchiolitis obliterans.
The patient was in the group of high risk for mycobacterial infection development and the course of her illness was typical. We decided however to present the case as the topic seems to be quite neglected in the literature.

Abstract

Patients after organ transplantations are at risk for mycobacteriosis development.
Frequency of the mycobacterial infection after bone marrow transplantation (BMT) is not as high as one could expect. It ranges from 0.4 to 4.9%.
We present a case of a female patient after allogenic BMT as a treatment of chronic myelogenous leucaemia, with bronchiolitis obliterans as a symptom of graft versus host disease (GvHD), treated with corticosteroids and infected with Mycobacterium avium.
She was admitted to the hospital with dyspnoea, cough with large amount of sputum production and subfebrile status. She had partial respiratory insufficiency and obturative disturbances of respiration (FEV1 0.67 l i.e. 22% of normal) with decline of VC (2.23 l i.e. 64% of normal). The high-resolution computed tomography (HRCT) revealed multifocal infiltrations and bronchiectases in the upper and middle pulmonary fields, which were absent in the previous HRCT taken 3 years earlier. In the bronchial secretion acid-fast bacilli were found by smear and culture. The isolate was classified as Mycobacterium avium complex (MAC) by high performance liquid chromatography (HPLC). The patient was treated with clarithromycin, ciprofloxacin, isoniazide (INH), ethambutol (EMB), amikacin, but M. avium was still present in the sputum after 3 months. Treatment was continued in her parent hospital, where after a few months her sputum became negative for M. avium. But she died over a year later from progressive respiratory insufficiency in the course of bronchiolitis obliterans.
The patient was in the group of high risk for mycobacterial infection development and the course of her illness was typical. We decided however to present the case as the topic seems to be quite neglected in the literature.
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Keywords

mycobacteriosis; bone marrow transplantation; bronchiolitis obliterans

About this article
Title

Mycobacterial infection caused by Mycobacterium avium in allogenic bone marrow transplant recipient with concomittant bronchiolitis obliterans as a manifestation of graft versus host disease - case report and review of the literature

Journal

Advances in Respiratory Medicine

Issue

Vol 76, No 2 (2008)

Pages

111-117

Published online

2008-04-28

Bibliographic record

Pneumonol Alergol Pol 2008;76(2):111-117.

Keywords

mycobacteriosis
bone marrow transplantation
bronchiolitis obliterans

Authors

Agnieszka Buraczewska
Anna Kempisty
Jan Kuś
Małgorzata Bartosiewicz

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