SHM Converge Scientific Abstract ePoster Gallery-Line-Associated Mycobacterium Mucogenicum/Phocaicum Bacteremia in a Patient With Sickle Cell Disease: A Rare Case of Rapidly Growing Nontuberculous Mycobacterial Infection

Line-Associated Mycobacterium Mucogenicum/Phocaicum Bacteremia in a Patient With Sickle Cell Disease: A Rare Case of Rapidly Growing Nontuberculous Mycobacterial Infection

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This case report describes a rare line-associated bloodstream infection due to rapidly growing nontuberculous mycobacteria (NTM), specifically <em>Mycobacterium mucogenicum/phocaicum</em>, in a 36-year-old man with sickle cell disease (HbSS) who received monthly exchange transfusions through a central venous catheter (CVC).

The patient presented with one day of chest pain, shortness of breath, fever, mild tachypnea, leukocytosis, and anemia. Blood cultures and sputum cultures grew <em>M. mucogenicum/phocaicum</em>, while QuantiFERON-TB testing was negative. His CVC was removed, though the catheter tip culture was negative. Infectious Disease recommended a 4-week course of ciprofloxacin and clarithromycin, a regimen commonly used for rapidly growing mycobacterial infections.

The report emphasizes that NTM are environmental acid-fast bacteria found in soil and water, and that bloodstream infections are rare but occur mainly in immunocompromised patients or those with indwelling vascular catheters. Sickle cell disease may increase susceptibility because of immune dysfunction, including impaired splenic function, phagocytic defects, complement abnormalities, and reduced IgG/IgM responses. Rapidly growing mycobacteria can also form biofilms, making catheter-related infection more likely.

There are currently no formal guidelines for the optimal antibiotic choice or treatment duration for NTM bloodstream infections, but combinations of two or more antibiotics for about four weeks, often a macrolide plus a quinolone, have shown favorable outcomes. The patient improved clinically and laboratory values normalized after treatment, and follow-up blood cultures were negative.

The main takeaway is that clinicians should consider NTM infection in patients with sickle cell disease who have a CVC and signs of infection, especially when routine workup is unrevealing.

Asset Subtitle

Natalie Torrente

Meta Tag

Author List Natalie Torrente, Ricky Buckshaw Jr.

Category Clinical Vignettes

Concept Nontuberculous mycobacteria

Concept Rapidly Growing Mycobacteria

Concept Bloodstream Infection

Concept Antituberculous Drug Resistance

Concept Environmental Reservoir

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Natalie Torrente

Track Adult

Keywords

nontuberculous mycobacteria

Mycobacterium mucogenicum/phocaicum

bloodstream infection

sickle cell disease

central venous catheter

rapidly growing mycobacteria

catheter-related infection

ciprofloxacin

clarithromycin

biofilm formation

Nontuberculous mycobacteria

Rapidly Growing Mycobacteria

Bloodstream Infection

Antituberculous Drug Resistance

Environmental Reservoir