A disseminated Mycobacterium marinum infection in a renal transplant HIV-infected patient successfully treated with a bedaquiline-containing antimycobacterial treatment: a case report

Abstract Background Mycobacterium marinum disseminated infections rarely affected immunocompromised patients. Treatment with prolonged multi-drug regimen, exposed them to frequent drug-drug interactions and side effects. Case report We reported a new case of Mycobacterium marinum disseminated infection in a 54-year-old renal transplant HIV-infected woman. Manifestations of the infection were cutaneous and sub-cutaneous nodules, mediastinal lymphnodes and left pulmonary infiltrate. Empirical treatment for nontuberculous Mycobacteria was first initiated with rifabutin, ethambutol, and azithromycin. After identification of M. marinum in sputum, regarding unfavourable clinical evolution and severe adverse events, treatment was changed for doxycyclin and rifabutin. Digestive and hematologic side effects motivated a new change of antimycobacterial treatment for a combination of moxifloxacin and bedaquiline. Tolerance was satisfactory. A twelve months treatment led to cure. Conclusion We report the first case of M. marinum infection successfully treated with a bedaquiline-containing regimen. Bedaquiline could constitute an alternative to recommended antimicrobial regimens in case of nontuberculous mycobacterial disease including M. marinum infection.