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J. Clin. Med. 2019, 8(2), 216; https://doi.org/10.3390/jcm8020216

Psoas Abscess Due to Mycobacterium avium in a Patient with Chronic Lymphocytic Leukemia—Case Report and Review

1
University Department of Medicine, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland
2
Infectious Diseases Service, University Department of Medicine, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland
3
Department of Radiology and Nuclear Medicine, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland
4
Neuroradiology Service, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
5
Cantonal Institute of Pathology, 4410 Liestal, Switzerland
6
Pathology Service, Viollier AG, 4055 Basel, Switzerland
7
Department of Medicine, Kantonsspital Baden, 5404 Baden, Switzerland
8
Oncology Service, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland
*
Author to whom correspondence should be addressed.
These authors contributed equally to the manuscript.
Received: 29 January 2019 / Revised: 5 February 2019 / Accepted: 5 February 2019 / Published: 7 February 2019
(This article belongs to the Section Oncology)
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Abstract

Infections may constitute a serious complication in patients with chronic lymphocytic leukemia (CLL). New treatment agents including obinutuzumab and ibrutinib have improved the progression-free survival in CLL, and data suggest a similar overall infection risk and a limited risk of opportunistic infections when compared to standard chemo-immunotherapy. Nevertheless, cases of opportunistic infections including non-tuberculous mycobacterial (NTM) in CLL patients have recently been published. We present a case of a 74-year old man with extensive prior CLL treatment history, including most recently obinutuzumab. He developed an abscess of the psoas muscle and inguinal lymphadenopathy. An inguinal node biopsy specimen showed infection with Mycobacterium avium, confirmed by broad-spectrum mycobacterial PCR, M. avium-specific PCR, and mycobacterial culture. This case and our literature review suggest that physicians should be aware of opportunistic infections in patients with CLL. Diagnostic differentiation from CLL disease progression, Richter’s transformation to aggressive lymphoma, and secondary malignancy relies on histological and appropriate microbiological studies from biopsy material of affected organs. Infection prophylaxis in CLL should be considered, including vaccinations and intravenous immune globulin replacement. View Full-Text
Keywords: Mycobacterium avium; abscess; infection; chronic lymphocytic leukemia; non-tuberculous mycobacteria; obinutuzumab; ibrutinib; immunosuppression Mycobacterium avium; abscess; infection; chronic lymphocytic leukemia; non-tuberculous mycobacteria; obinutuzumab; ibrutinib; immunosuppression
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MDPI and ACS Style

Diaco, N.D.; Strohdach, B.; Falkowski, A.L.; Hainc, N.; Brunner, P.; Rutishauser, J.; Jost, L.; Tarr, P.E. Psoas Abscess Due to Mycobacterium avium in a Patient with Chronic Lymphocytic Leukemia—Case Report and Review. J. Clin. Med. 2019, 8, 216.

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