Acute kidney injury in a patient with nontuberculous mycobacterial infections: a case report
© Brener et al; licensee BioMed Central Ltd. 2009
Received: 09 November 2008
Accepted: 23 January 2009
Published: 23 January 2009
Nontuberculous mycobacterial infections are an increasingly recognized cause of chronic lung disease in both immunocompromised and immunocompetent patients. Pre-existing lung disease, alcohol abuse, diabetes mellitus, malignancy, and smoking have been identified as important risk factors in nontuberculous mycobacterial infections, with only few cases of Nontuberculous mycobacterial infection in renal failure patients, mostly on peritoneal dialysis. However, acute kidney injury associated with atypical mycobacterial infection is a very rare clinical event. To our knowledge, the present patient is the first case of acute kidney injury in a patient with documented nontuberculous mycobacterial infection. Our case is also a first report of Mycobacteria avium complex and Mycobacteria gordonae isolated simultaneously from individual patient with nontuberculous mycobacterial disease.
Nontuberculous mycobacterial (NTM) infections are an increasingly recognized cause of chronic lung disease in both immunocompromised and immunocompetent patients [1, 2]. Pre-existing lung disease, alcohol abuse, diabetes mellitus, malignancy, and smoking have been identified as important risk factors in NTM , with only few cases of NTM infection in renal failure patients, mostly on peritoneal dialysis . However, acute kidney injury (AKI) associated with NTM infection is a very rare clinical event. To our knowledge, the present patient is the first case of AKI in a patient with documented NTM infection. This is also the first reported case of M. avium complex and M. gordonae isolated simultaneously from individual patient with NTM disease.
Pulmonary disease due to NTM typically occurs in patients with impaired cellular immunity or chronic lung disease . Recently, there has been an increase in the number of reports of pulmonary disease caused by NTM occurring in otherwise healthy individuals, and the M. avium complex (MAC), and M. kansasii account for most of the pathogens involved . Signs and symptoms of NTM lung disease are often variable and nonspecific. Patients frequently present with chronic cough, productive sputum, and fatigue . The radiographic criteria required are the presence of infiltrates, cavitations, or nodules at chest radiography, and/or multiple small nodules or multifocal bronchiectasis at CT of the chest .
MAC is the most commonly isolated and the most clinically important pulmonary NTM pathogen, and includes the two species M. avium and M. intracellulare . The fact that they are distinct has no clinical value for individual patients, however, and they are generally not differentiated. To our best knowledge, simultaneous isolation of both MAC and M. gordonae from respiratory secretion of the same patient has never been described in a literature.
Coexisting medical conditions have been identified by studies throughout the world as important risk factors, with only few cases of NTM infection in renal failure patients, mostly on peritoneal dialysis . An important role of infection-related mediator mechanisms in the genesis of AKI has been well recognized. However, AKI associated with NTM infection is a very rare clinical event. To our knowledge, the present patient is the first case of AKI in a patient with documented NTM infection. The chronological sequence of renal failure and recovery in the context of NTM infection raises a possibility that the renal injury might be at least partly due to direct infection and/or immune-mediated damage.
Because of the increasing number of immunocompromised patients, immigrants, refugees, patients in congregate setting, and patients with drug-resistant disease, it is possible that renal involvement will be recognized among the presentations of NTM infection. Physicians should be aware of the possibility of NTM infection presenting with AKI, and our case report may help to elucidate the mechanisms of renal impairment in NTM infection. Increased number of cases of NTM disease caused by more than one pathogen can be also expected.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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