Mycobacterium tuberculosis Surgical Site Infection after Cardiac Surgery in the COVID-19 Era: A Case Report

Abstract

Infection of surgical wounds with acid-fast bacilli, including tubercle bacilli, is rare, and is poorly described in the literature. We present the case of a 74-year-old male who developed a sternal wound infection after cardiac surgery due to Mycobacterium tuberculosis complex, diagnosed post-mortem. SARS-CoV-2 infection contributed to worsened clinical conditions and surgical site infection. A high degree of suspicion to avoid unnecessary treatments and progression to severe disease with dismal prognosis is necessary in these types of infections.

Keywords: Mycobacterium tuberculosis; heart surgery; sternal wound; surgical site infection.

Figure 1

(A). Clinical picture of the two dehiscences in the upper and lower third of the sternotomy scar (arrows); (B). Three-dimensional volume-rendered CT images show sternal bone rarefaction areas in the upper and lower third of the sternum (arrows).

Figure 2

(A,B). Hematoxylin and eosin stain, original magnification 40×. The specimen was characterized by abundant fibrinoid material with numerous erythrocytes and granulocytes and by granulomatous inflammatory infiltrates with a vaguely nodular pattern composed of histiocytes and multinucleated giant cells; (C). CD68 stain (clone PG-M1), original magnification 40×. The histiocytes were highlighted by a CD68 stain. (D). Periodic acid–Schiff (PAS) stain, original magnification 40×. PAS was negative for fungal organisms. The Ziehl–Neelsen stain was also negative for Mycobacteria (not shown).