Repeated acute kidney injury associated with Mycobacterium gordonae infection

Mycobacterium gordonae is a nontuberculous mycobacterium widely distributed in the environment. Although M. gordonae is not usually pathogenic and glomerular lesions due to M. gordonae are very rare, infection has been reported in both immunocompromised patients and healthy persons. We report a case of acute kidney injury (AKI) in which M. gordonae was ultimately identified as the cause. A 70-year-old man was admitted to our hospital because of fever, polyarthritis, and AKI. He was a hepatitis B virus carrier, suffered from diabetes, and had a past history of erysipelas. No causative bacteria were identified, but coexisting infection was suspected. The patient experienced remission with antibiotic therapy, but the same symptoms recurred eight times. Blood polymerase chain reaction was performed during the 7th recurrence, and M. gordonae was detected. Clarithromycin was initiated, but 2 years after initial hospitalization, the patient died due to M. gordonae infection. In this case, acute kidney injury was a consequence of infection-related glomerulonephritis due to M. gordonae. Mycobacterium is difficult to detect by routine culture methods; therefore, diagnosis remains challenging.