ABSTRACT
Context: Disseminated infections due to Mycobacterium bovis Bacillus Calmette-Guérin (BCG) are unusual and occur mostly in patients with inborn error of immunity (IEI) or acquired immunodeficiency. However, cases of secondary BCGosis due to intravesical BCG instillation have been described. Herein, we present a case of severe BCGosis occurring in an unusual situation. Case Description: We report one case of severe disseminated BCG disease occurring after hematological malignancy in a 48-year-old man without BCG instillation and previously vaccinated in infancy with no complication. Laboratory investigations demonstrated that he was not affected by any known or candidate gene of IEI or intrinsic cellular defect involving IFNγ pathway. Whole genome sequencing of the BCG strain showed that it was most closely related to the M. bovis BCG Tice strain, suggesting an unexpected relationship between the secondary immunodeficiency of the patient and the acquired BCG infection. Conclusion: This case highlights the fact that, in addition to the IEI, physicians, as well as microbiologists and pharmacists should be aware of possible acquired disseminated BCG disease in secondary immunocompromised patients treated in centers that administrate BCG for bladder cancers.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Hematologic Neoplasms/drug therapy , Immune Reconstitution , Immunocompromised Host , Mycobacterium bovis/pathogenicity , Opportunistic Infections/microbiology , Tuberculosis, Pulmonary/microbiology , Administration, Intravesical , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antitubercular Agents/therapeutic use , BCG Vaccine/administration & dosage , BCG Vaccine/adverse effects , Host-Pathogen Interactions , Humans , Male , Middle Aged , Mycobacterium bovis/drug effects , Mycobacterium bovis/immunology , Opportunistic Infections/drug therapy , Opportunistic Infections/immunology , Risk Factors , Treatment Outcome , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/immunology , Urinary Bladder Neoplasms/drug therapy , Urinary Bladder Neoplasms/immunologyABSTRACT
OBJECTIVE: To report the association of JC virus infection of the brain (progressive multifocal encephalopathy [PML]) during the course of sarcoidosis and the challenging balance between immune reconstitution under targeted cytokine interleukin 7 (IL7) therapy for PML and immunosuppression for sarcoidosis. METHODS: Original case report including deep sequencing (whole-exome sequencing) to exclude a primary immunodeficiency (PID) and review of the literature of cases of PML and sarcoidosis. RESULTS: We report and discuss here a challenging case of immune reconstitution with IL7 therapy for PML in sarcoidosis in a patient without evidence for underling PID or previous immunosuppressive therapy. CONCLUSIONS: New targeted therapies in immunology and infectiology open the doors of more specific and more specialized therapies for patients with immunodeficiencies, autoimmune diseases, or cancers. However, before instauration of these treatments, the risk of immune reconstitution inflammatory syndrome and potential exacerbation of an underlying disease must be considered. It is particularly true in case of autoimmune disease such as sarcoidosis or lupus.
Subject(s)
Immune Reconstitution Inflammatory Syndrome/diagnosis , Interleukin-7/pharmacology , Leukoencephalopathy, Progressive Multifocal/drug therapy , Sarcoidosis/diagnosis , Humans , Interleukin-7/administration & dosage , Interleukin-7/adverse effects , Male , Middle Aged , Exome SequencingSubject(s)
Endocarditis, Bacterial/complications , Magnetic Resonance Imaging , Posterior Leukoencephalopathy Syndrome/microbiology , Posterior Leukoencephalopathy Syndrome/pathology , Staphylococcal Infections/complications , Diagnosis, Differential , Endocarditis, Bacterial/surgery , Female , Foramen Ovale, Patent/complications , Foramen Ovale, Patent/surgery , Humans , Middle Aged , Staphylococcal Infections/surgery , Stroke/diagnosis , Tricuspid Valve Insufficiency/complications , Tricuspid Valve Insufficiency/surgeryABSTRACT
Chronic meningococcaemia is an unusual clinical presentation of Neisseria meningitidis infection. We describe the case of a patient, who presented with total IgA deficiency and partial IgM deficiency with a low switched memory B cells count, suggestive of a borderline form of common variable immunodeficiency (CVID). The role of IgA in the protection against Neisseria meningitidis, and the link between IgA deficiency and CVID are discussed.
