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Case Reports: Rare disease
Metagenomic next-generation sequencing identifying a rare case of Mycobacterium xenopi discitis
  1. Ali Zagham Nasir1,
  2. Nnaemeka Egwuatu2 and
  3. Andrew Jameson2
  1. 1Internal Medicine Residency, Trinity Health Michigan, Grand Rapids, Michigan, USA
  2. 2Infectious Disease, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
  1. Correspondence to Dr Ali Zagham Nasir; ali.nasir{at}trinity-health.org

Abstract

Mycobacterium xenopi is a non-tuberculous mycobacterium (NTM) that sporadically causes infections in humans and can cause rare bone and joint infections in immunocompromised hosts with history of spinal surgery. This slow-growing mycobacterium takes 8–12 weeks to grow on culture. Metagenomic next-generation sequencing (MNGS) is a highly sensitive and specific plasma-based microbial cell-free DNA test that can detect M. xenopi weeks prior to culture growth. We present a case of M. xenopi lumbosacral discitis with presacral abscess in an immunocompromised woman without history of spinal surgery which was detected by MNGS 8 weeks prior to culture growth. The patient’s discitis resolved with an M. xenopi-directed regimen of ethambutol, rifampin and azithromycin. This case illustrates the utility of next-generation sequencing tests in rapid diagnosis of rare and opportunistic infections, as compared with traditional diagnostic tests, with supporting contextual clinical and diagnostic findings.

  • Infectious diseases
  • Bone and joint infections
  • Rheumatology
  • Orthopaedics
  • Medical management

https://doi.org/10.1136/bcr-2023-255594

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    Footnotes

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    • Contributors All authors saw the patient. AZN collected and organised the data and drafted the paper. NE and AJ reviewed and edited the paper. AZN and AJ gave informed consent to the patient, and AJ signed the consent form. All authors reviewed the final version prior to submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.