Multiple Myeloma Coverage from Every Angle

Mycobacterium Abscessus and SARS–CoV-2 Coinfection: Case Report in Myeloma

By: Kelly M. Hennessey, PhD
Posted: Monday, March 22, 2021

SARS–CoV-2 infections and infections with Mycobacterium abscessus may present with similar symptoms, but treatment plans differ significantly. Paula A. Eckardt, MD, of Memorial Regional Hospital, Hollywood, Florida, and colleagues described the case of an elderly patient who had multiple myeloma that was not in remission and tested positive for COVID-19. Highlighted in Case Reports in Infectious Diseases, this case features the clinical importance of a broad differential diagnosis and consideration of multiple coinfections to provide goal-directed therapy.

An 84-year-old man undergoing treatment for multiple myeloma presented to an emergency department to rule out COVID-19 infection before starting another chemotherapy cycle. The patient had nonspecific symptoms and was admitted to the hospital after a confirmed diagnosis of mild COVID-19 pneumonia.

Initially, his symptoms were unremarkable except for spikes in temperature and mild hypoxia. The sixth day after admission, he presented with hematochezia. His hemoglobin levels dropped from 10 mg/dL to 7.1 mg/dL. He experienced acute hypoxemic respiratory failure and was reassessed for severe multifocal COVID-19 pneumonia, and was administered antibiotics for a secondary bacterial infection. After cardiac arrest, he was reintubated and mechanically ventilated. A chest x-ray showed worsening infiltrates, and repeat blood and sputum cultures confirmed acid-fast beaded bacilli. Antibiotics were upgraded to treat possible nocardia infection. He experienced multisystem organ failure with septic shock and acute respiratory distress syndrome complicated by acid-fast bacillus bacterial infection. After 2 months in the hospital, the patient died.

“Even when patients seem to be primarily infected with COVID-19 and are critically ill, it is important to assess for other differentials such as superimposed infections, especially in the immunocompromised population, as proper antimicrobial therapy can alter outcomes,” they concluded.  

Disclosure: The study authors reported no conflicts of interest.

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