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Case Reports
. 2022 Dec 9;21(1):57.
doi: 10.1186/s12941-022-00547-x.

Disseminated Mycobacterium chimaera infection favoring the development of Kaposi's sarcoma: a case report

Tommaso Clemente  1   2 , Vincenzo Spagnuolo  3 , Martina Bottanelli  4   3 , Marco Ripa  3 , Benedetto Del Forno  5 , Elena Busnardo  6   7 , Giuseppe Di Lucca  8 , Antonella Castagna  4   3 , Anna Danise  3
Affiliations
Case Reports

Disseminated Mycobacterium chimaera infection favoring the development of Kaposi's sarcoma: a case report

Tommaso Clemente et al. Ann Clin Microbiol Antimicrob. .

Abstract

Background: Disseminated Mycobacterium chimaera infection is an emerging disease in people undergone to cardiothoracic surgery, which need to be suspected also with atypical presentations.

Case presentation: We report the case of a 74-year-old man with fever of unknown origin, purple nodules on both feet and a history of open-heart surgery. Imaging investigations showed an abscess near aortic bioprosthesis but screening for endocarditis resulted negative and pyrexia did not respond to antibiotic therapy. A biopsy of cutaneous lesions showed HHV8-related Kaposi's sarcoma, so bone marrow biopsy was executed with evidence of HHV8 localization. Bone marrow and urine mycobacterial cultures resulted positive for M. chimaera and a specific antimicrobial therapy was started, with apyrexia after 7 weeks.

Conclusions: M. chimaera infection should be always investigated as a possible etiology of fever of unknow origin in people with a history of open-heart surgical intervention, even with negative mycobacterial blood cultures. The possible role of disseminated infection in inducing immunodepression with the occurrence of other opportunistic diseases (such as Kaposi's sarcoma) cannot be excluded.

Keywords: HHV8; Infective endocarditis; Kaposi; Mycobacterium chimaera; Non-tuberculous mycobacteria.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patient’s daily body temperature, treatments and microbiological investigations. The highest daily body temperature from May to December 2021 was reported in degrees Celsius (°C). Only concurrent antibiotic and anti-inflammatory treatments and microbiological investigations inherent to mycobacterial and human herpesvirus 8 (HHV8) infections were shown. In the susceptibility test, susceptibility and resistance to a specific antibiotic were evaluated comparing minimum inhibitory concentration to Clinical and Laboratory Standard Institute clinical breakpoints, when available [10]. A amoxicillin-clavulanic acid, HHV8 human herpesvirus 8, M meropenem, MIC minimum inhibitory concentration, N naproxen, R resistant, S susceptible
Fig. 2
Fig. 2
Heart and skin findings. a Total body Fluorine-18-fluorodeoxyglucose positron emission tomography executed in June 2021 showing an accumulation of the tracer near the aortic bioprosthesis. b Cutaneous lesions on the right foot of the patient, which were biopsied in July 2021
See this image and copyright information in PMC

References

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