Introduction:

With an increasing rate of non-tuberculous mycobacterial infections globally, there is a high demand for research on markers of diagnosis, knowledge from previous cases, and treatment options. Commonly found through contaminated water, soil, and animal products, mycobacterial infections can present with skin infections and can have severe pulmonary consequences, requiring months of antibiotic treatment. Under 30 cases have been reported of Mycobacterium conceptionense infection. Cases have been reported in France, Iran, and South Korea among other areas. In the United States, there have been three reported cases of M. conceptionense infection, all of which were in the midwestern Chicago, Illinois area. We report the first case of a M. conceptionense infection in the Southeastern part of the USA in Memphis, Tennessee. Additionally, to date, no prior cases have been reported after an organ transplant or in relation to diabetes requiring insulin.

Case Presentation: A 70-year-old African American woman with history of insulin-dependent diabetes and end-stage kidney disease status post cadaveric renal transplant 8 years prior, presented to clinic with a painful abdominal wall abscess which developed 3 weeks prior at the site of subcutaneous insulin injections. At the time of presentation, the lesion appeared as a fluctuant mass measuring 6cm with surrounding erythema, tender and warm to touch. The abscess was surgically drained and custard-like pus was encountered. The sample was sent for testing and returned positive on direct AFB smear and Mycobacterium conceptionense was suspected based on DNA probe analysis. The isolate was sent to National Jewish Mycobacteriology Reference Laboratory for official identification and susceptibility testing where and rpoB gene sequence analysis and a line probe assay identification test were conducted. Results strongly supported Mycobacterium conceptionense, as other species were ruled out. Extensive in vitro antibiotic susceptibility guided antibiotic use alongside patient’s other health conditions. Final Diagnosis:

Abdominal abscess infection with Mycobacterium conceptionense. Management/Outcome:

The final antibiotic regimen was doxycycline-100mg twice daily and Augmentin-250/125mg twice daily. This patient presents a unique, delicate case where proper treatment required management of several other medications, diagnoses, and co-morbidities.

References

Winthrop, K., Eagle, G., Laan, R. V., Zhang, R., & Zhang, Q. (2018). Population-based incidence and prevalence of nontuberculous mycobacterial lung disease in a large US managed care health plan, 2008 – 2015. Pneumologie, 72(S 01). doi:10.1055/s-0037-1619373

Faria, S., Joao, I., & Jordao, L. (2015). General Overview on Nontuberculous Mycobacteria, Biofilms, and Human Infection. Journal of Pathogens, 2015, 1-10. doi:10.1155/2015/809014 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448615/