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Extensive Mycobacterium abscessus Pneumonia in an Immunocompetent Infant with No Underlying Lung Pathology

Morouge M Alramadhan1, James R Murphy1, Michael L Chang1

  • 1Department of Pediatrics, Division of Pediatric Infectious Diseases, UTHealth McGovern Medical School, Houston, TX, USA.

Case Reports in Infectious Diseases
|April 21, 2021
PubMed

Insights

A rare pulmonary infection caused by Mycobacterium abscessus occurred in an immunocompetent infant. Early, comprehensive evaluation and genetic testing are crucial for effective treatment of this challenging condition.

Area of Science:

  • Pediatric Pulmonology
  • Infectious Diseases
  • Medical Genetics

Background:

  • Pulmonary infection with Mycobacterium abscessus (M. abscessus) is uncommon in immunocompetent children without pre-existing lung conditions.
  • Treatment is often challenging due to high rates of antibiotic resistance in M. abscessus isolates.

Observation:

  • A 4-month-old infant presented with persistent cough, feeding difficulties, and failure to thrive.
  • Extensive M. abscessus pulmonary infection was confirmed via culture, despite a thorough evaluation ruling out immunodeficiency and underlying lung pathology.

Findings:

  • Whole-exome sequencing was utilized as part of a comprehensive immunodeficiency evaluation.
  • The M. abscessus isolate exhibited a complex antibiotic susceptibility pattern, guiding treatment selection and duration.
  • Literature review on nontuberculous mycobacterial pulmonary disease in immunocompetent children was performed.

Implications:

  • A multidisciplinary approach is essential for pediatric patients diagnosed with M. abscessus pneumonia, including evaluation for lung disease and immunodeficiencies.
  • Assessing macrolide susceptibility via erm(41) gene analysis is critical for guiding therapy in cases with unusual susceptibility profiles.

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