DISSEMINATED MYCOBACTERIUM AVIUM COMPLEX IN A LUNG TRANSPLANT PATIENT WITHOUT ALLOGRAFT INVOLVEMENT

TOPIC: Transplantation TYPE: Fellow Case Reports INTRODUCTION: Nontuberculous mycobacteria (NTM) infections are a known complication in immunocompromised patients. Solid organ transplant patients at increased risk, with lung recipients comprising 55.9% of infections. Amongst recipients, rates pulmonary disease due to NTM can be as high 6.5%. We present unique case bilateral patient who developed disseminated mycobacterium avium complex (MAC) infection without any evidence allograft involvement. CASE PRESENTATION: Our is sixty eight year old male past medical history idiopathic fibrosis received sequential 2011. He had an uncomplicated course for many years, but 2014 fevers and "cysts" on his right elbow. underwent incision drainage the nodular cystic lesions cultures grew (MAC). required subsequent excision three nodules elbow, one left well aspiration knee effusion, all growing MAC. Patient was treated azithromycin, ethambutol, moxifloxacin, later changed rifabutin two years. There were no issues after treatment. September 2020, he became symptomatic again effusion area fluctuance adjacent which open debridement washout joint failing conservative management. All undergoing repeat treatment rifabutin, azithromycin based sensitivity panels, show macrolide resistance. has respiratory or other systemic symptoms. Surveillance radiological studies dating back more than 10 including CT scans chest, have never shown active infection. Review patient's bronchoalveolar lavage cultures, bronchial washes transbronchial biopsies done part post surveillance not revealed sign DISCUSSION: cause morbidity solid patients, particularly recipients. Disseminated involvement rarely been reported literature. could only find instance whom presenting site MAC hepatic resulting portal hypertension concomitant In series Mycobacterial transplantation, cases found BAL. CONCLUSIONS: unusual demonstrates that occur absence presence skin lesions, bone symptoms should prompt further investigation being differential diagnosis. REFERENCE #1: Henkle, E., Winthrop, K., Mycobacteria Infections Immunosuppressed Hosts. Clinics Chest Medicine, 2015-03-01, Volume 36, Issue 1, 91-99. #2: Keating, M.R., Daly, J.S. (2013), Organ Transplantation. American Journal Transplantation, 13: 77-82. doi:10.1111/ajt.12101 #3: Todd JL, Lakey J, Howell D, Reidy M, Zaas D. Portal granulomatous liver recipient atypical mycobacterial Am. J. Transplant.7, 1300–1303 (2007) DISCLOSURES: No relevant relationships by Thomas Kaleekal, source=Web Response Diego Marin,