Disseminated Mycobacterium kansasii infection with osseous involvement in anti-interferon-γ autoantibody-associated adult-onset immunodeficiency: a case report and literature review
Abstract
Background: Anti-interferon-γ autoantibody-associated adult-onset immunodeficiency is a rare acquired immunodeficiency that predisposes patients to recurrent or disseminated opportunistic infections, particularly nontuberculous mycobacterial (NTM) infections. Disseminated Mycobacterium kansasii infection in this setting is uncommon and may radiologically mimic malignancy, leading to diagnostic delay.
Case presentation: A 53-year-old Chinese man with untreated chronic hepatitis B virus (HBV) infection presented with cough, chest pain, and back pain. Chest computed tomography and ^18F-FDG PET/CT revealed a left hilar mass, mediastinal and hilar lymphadenopathy, and extensive FDG-avid skeletal lesions, initially suggesting lung cancer with bone metastases. However, repeated pathological examinations, including bronchoscopic brushing, endobronchial ultrasound-guided transbronchial needle aspiration, and cervical lymph node aspiration, failed to confirm malignancy. Targeted next-generation sequencing of bronchoalveolar lavage fluid and metagenomic next-generation sequencing of vertebral tissue both identified Mycobacterium kansasii, supporting disseminated infection with pulmonary and skeletal involvement. Subsequent immunologic testing demonstrated elevated anti-IFN-γ autoantibodies, supporting a clinical diagnosis of AIGA-associated disseminated M. kansasii infection. Antimycobacterial therapy was initiated, but further treatment was complicated by postoperative cholestatic…
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