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Immune reconstitution inflammatory syndrome in Mycobacterium chimaera mediastinitis: When clinical judgment trumps

Sara Haddad1, Ralph Tayyar1, Lawrence Livornese Jr2

  • 1Department of Internal Medicine, Lankenau Medical Center, Wynnewood, PA, USA.

International Journal of Mycobacteriology
|March 12, 2021
PubMed

Insights

Mycobacterium chimaera infection can cause serious complications. Immune Reconstitution Inflammatory Syndrome (IRIS) should be suspected in immunocompetent patients undergoing treatment for nontuberculous mycobacteria.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Cardiovascular Surgery

Background:

  • Mycobacterium chimaera infections have been linked to contaminated heater-cooler units used in cardiac surgery.
  • Immune Reconstitution Inflammatory Syndrome (IRIS) is typically observed in immunocompromised individuals, particularly those with HIV initiating therapy.

Observation:

  • A 52-year-old immunocompetent male developed Mycobacterium chimaera mediastinitis one year post-Type A dissection repair.
  • The patient experienced declining kidney function, pancytopenia, and hypercalcemia during antimicrobial treatment for M. chimaera.

Findings:

  • Bone marrow and kidney biopsies confirmed that the patient's symptoms were indicative of IRIS.
  • The diagnosis of IRIS in this immunocompetent patient occurred 8 months into quadruple antimicrobial therapy.

Implications:

  • This case highlights that IRIS can occur in immunocompetent individuals during nontuberculous mycobacteria treatment.
  • Timely diagnosis of IRIS can prevent unnecessary diagnostic procedures and interventions, potentially avoiding further surgery.

Keywords:
Immune reconstitution inflammatory syndromeMycobacterium chimaeramediastinitisnontuberculous mycobacteriumpostoperative cardiovascular infections

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