Refractory Osteomyelitis Caused by Mycobacterium aubagnense and Its L-Form: Case Report and Review of the Literature

Abstract

Purpose

To report a rare case of tibial osteomyelitis caused by Mycobacterium aubagnense and its L-form, to systematically review non-tuberculous mycobacteria (NTM) infections of the bones, and to summarize the medication guidelines for infections with NTM and its L-forms.

Methods

Case report and literature review.

Results

We report a 31-year-old HIV-positive man who developed osteomyelitis caused by M. aubagnense and its L-form. Culture, electron microscopy, polymerase chain reaction assay, and a reversion test confirmed the existence of M. aubagnense. The patient was treated with surgical debridement and a combination of systemic antibiotics, and continued to take antiretroviral treatment. Some clinical improvement was noted shortly after the initiation of this treatment. Resolution of osteomyelitis was achieved after 10 months. We also systematically reviewed cases of NTM osteomyelitis in the PubMed database and compared antibiotic sensitivity between L-forms and their prototype bacteria. We have summarized the treatment regimens for infections of the bone and bone marrow caused by NTM and their L-forms.

Conclusion

We have reported the first case of refractory osteomyelitis caused by M. aubagnense and its L-form in a patient with immune deficiency, reviewed the literature on NTM osteomyelitis, and compared the antibiotic sensitivity of L-forms and their prototype bacteria.

Keywords:

• non-tuberculous mycobacteria
• HIV
• bone and bone marrow infection

Abbreviations

NTM, non-tuberculosis mycobacteria; HPLC, high-performance liquid chromatography; NGS, next-generation sequencing; DHT, DNA hybridization technology; WGS, whole genome sequencing; NAC, nucleic acid chromatography; MAC, Mycobacterium avium complex; FOX, cefoxitin; CIP, ciprofloxacin; CLARY, clarithromycin; IPM, imipenem; LZD, linezolid; MXF, moxifloxacin; AZT, azithromycin; RFP, rifampicin; INH, isoniazid; PZD, pyrazinamide; VAN, vancomycin; AZM, azithromycin; MIN, minocycline; EMB, ethambutol; AMK, amikacin; MEM, meropenem; DOX, doxycycline; LVFX, levofloxacin; TMP/SMX, trimethoprim/sulfamethoxazole; CLO, clofazolamide; DAP, daptomycin; NAP, naproxen; AMX, amoxicillin.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Ethics Approval and Informed Consent

This case report was approved by the ethics committee of Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University. The patient provided written informed consent. The study was carried out in accordance with the principles of the Declaration of Helsinki. The first author vouches for the completeness and accuracy of the data and for the fidelity of the study to the protocol.

Consent for Publication

Signed consent was obtained for the publication of the case details from the patient.

Acknowledgments

We thank the patient who participated in this study for his cooperation.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors have no conflicts of interest to declare in this work.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.