A Case of Granulomatous Interstitial Nephritis Associated with <i>Mycobacterium chimaera</i> Disseminated Infection
<i>Mycobacterium chimaera</i> infections are becoming increasingly frequent in patients with a history of cardiac surgery. We herein report a case of a patient admitted to the Nephrology Unit of Padua University Hospital with deteriorating kidney function, pancytopenia, hypercalcemia, an...
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2025-04-01
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| author | Martina Cacciapuoti Maria Mazzitelli Elena Naso Maria Loreta De Giorgi Giovanni Samassa Valentina Di Vico Serena Marinello Lucia Federica Stefanelli Lorenzo Calò Annamaria Cattelan Federico Nalesso |
| author_facet | Martina Cacciapuoti Maria Mazzitelli Elena Naso Maria Loreta De Giorgi Giovanni Samassa Valentina Di Vico Serena Marinello Lucia Federica Stefanelli Lorenzo Calò Annamaria Cattelan Federico Nalesso |
| author_sort | Martina Cacciapuoti |
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| description | <i>Mycobacterium chimaera</i> infections are becoming increasingly frequent in patients with a history of cardiac surgery. We herein report a case of a patient admitted to the Nephrology Unit of Padua University Hospital with deteriorating kidney function, pancytopenia, hypercalcemia, and respiratory symptoms that emerged seven years after they underwent heart surgery for prosthetic aortic valve replacement. A kidney biopsy revealed non-caseating necrotizing granulomatous interstitial nephritis, which was initially diagnosed as idiopathic granulomatous interstitial nephritis. The patient was treated with intravenous corticosteroids since no active infections, including mycobacterial infections, were detected. The negativity of the <i>Mycobacterium</i> molecular test following the kidney biopsy delayed the diagnosis of a <i>Mycobacterium chimaera</i> disseminated infection with endocarditis, myositis, cerebral, and kidney involvement, as blood cultures were available only after six weeks. The patient was started on antimicrobial therapy with azithromycin, moxifloxacin, rifampicin, and ethambutol while prednisone was tapered down, leading to an improvement in kidney function, blood count, and blood calcium level. Our case suggests that a <i>Mycobacterium chimaera</i> infection should be considered for patients with a history of cardiac surgery and granulomatous interstitial nephritis even in the absence of mycobacteria in a kidney biopsy. |
| format | Article |
| id | doaj-art-4d83eae89c0e427ea97d83466db0da9c |
| institution | DOAJ |
| issn | 2076-2607 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | MDPI AG |
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| series | Microorganisms |
| spelling | doaj-art-4d83eae89c0e427ea97d83466db0da9c2025-08-20T03:14:36ZengMDPI AGMicroorganisms2076-26072025-04-01135101910.3390/microorganisms13051019A Case of Granulomatous Interstitial Nephritis Associated with <i>Mycobacterium chimaera</i> Disseminated InfectionMartina Cacciapuoti0Maria Mazzitelli1Elena Naso2Maria Loreta De Giorgi3Giovanni Samassa4Valentina Di Vico5Serena Marinello6Lucia Federica Stefanelli7Lorenzo Calò8Annamaria Cattelan9Federico Nalesso10Nephrology, Dialysis and Transplantation Unit, University Hospital of Padova, 35128 Padova, ItalyInfectious and Tropical Disease Unit, University Hospital of Padova, 35128 Padova, ItalyNephrology, Dialysis and Transplantation Unit, University Hospital of Padova, 35128 Padova, ItalyNephrology, Dialysis and Transplantation Unit, University Hospital of Padova, 35128 Padova, ItalyNephrology, Dialysis and Transplantation Unit, University Hospital of Padova, 35128 Padova, ItalyNephrology, Dialysis and Transplantation Unit, University Hospital of Padova, 35128 Padova, ItalyInfectious and Tropical Disease Unit, University Hospital of Padova, 35128 Padova, ItalyNephrology, Dialysis and Transplantation Unit, University Hospital of Padova, 35128 Padova, ItalyNephrology, Dialysis and Transplantation Unit, University Hospital of Padova, 35128 Padova, ItalyInfectious and Tropical Disease Unit, University Hospital of Padova, 35128 Padova, ItalyNephrology, Dialysis and Transplantation Unit, University Hospital of Padova, 35128 Padova, Italy<i>Mycobacterium chimaera</i> infections are becoming increasingly frequent in patients with a history of cardiac surgery. We herein report a case of a patient admitted to the Nephrology Unit of Padua University Hospital with deteriorating kidney function, pancytopenia, hypercalcemia, and respiratory symptoms that emerged seven years after they underwent heart surgery for prosthetic aortic valve replacement. A kidney biopsy revealed non-caseating necrotizing granulomatous interstitial nephritis, which was initially diagnosed as idiopathic granulomatous interstitial nephritis. The patient was treated with intravenous corticosteroids since no active infections, including mycobacterial infections, were detected. The negativity of the <i>Mycobacterium</i> molecular test following the kidney biopsy delayed the diagnosis of a <i>Mycobacterium chimaera</i> disseminated infection with endocarditis, myositis, cerebral, and kidney involvement, as blood cultures were available only after six weeks. The patient was started on antimicrobial therapy with azithromycin, moxifloxacin, rifampicin, and ethambutol while prednisone was tapered down, leading to an improvement in kidney function, blood count, and blood calcium level. Our case suggests that a <i>Mycobacterium chimaera</i> infection should be considered for patients with a history of cardiac surgery and granulomatous interstitial nephritis even in the absence of mycobacteria in a kidney biopsy.https://www.mdpi.com/2076-2607/13/5/1019<i>Mycobacterium chimaera</i>disseminated infectiongranulomatous interstitial nephritiscardiac surgery |
| spellingShingle | Martina Cacciapuoti Maria Mazzitelli Elena Naso Maria Loreta De Giorgi Giovanni Samassa Valentina Di Vico Serena Marinello Lucia Federica Stefanelli Lorenzo Calò Annamaria Cattelan Federico Nalesso A Case of Granulomatous Interstitial Nephritis Associated with <i>Mycobacterium chimaera</i> Disseminated Infection Microorganisms <i>Mycobacterium chimaera</i> disseminated infection granulomatous interstitial nephritis cardiac surgery |
| title | A Case of Granulomatous Interstitial Nephritis Associated with <i>Mycobacterium chimaera</i> Disseminated Infection |
| title_full | A Case of Granulomatous Interstitial Nephritis Associated with <i>Mycobacterium chimaera</i> Disseminated Infection |
| title_fullStr | A Case of Granulomatous Interstitial Nephritis Associated with <i>Mycobacterium chimaera</i> Disseminated Infection |
| title_full_unstemmed | A Case of Granulomatous Interstitial Nephritis Associated with <i>Mycobacterium chimaera</i> Disseminated Infection |
| title_short | A Case of Granulomatous Interstitial Nephritis Associated with <i>Mycobacterium chimaera</i> Disseminated Infection |
| title_sort | case of granulomatous interstitial nephritis associated with i mycobacterium chimaera i disseminated infection |
| topic | <i>Mycobacterium chimaera</i> disseminated infection granulomatous interstitial nephritis cardiac surgery |
| url | https://www.mdpi.com/2076-2607/13/5/1019 |
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