Disseminated Mycobacterium kansasii and Mycobacterium avium complex co-infection in GATA2 mutated myelodysplastic syndrome: a case report

A 79-year-old female diagnosed with myelodysplastic syndrome (MDS) and germline GATA2 mutation, on compassionate cobimetinib, was admitted with subacute cough and dyspnea. Chest imaging demonstrated a new, large, left hilar mass and consolidation with scattered diffuse mediastinal, supraclavicular, and hilar lymphadenopathy. A core biopsy of the right supraclavicular lymph node was performed. Acid-fast bacilli (AFB) cultures from both the lymph node and blood were positive, while all fungal cultures were negative. Two distinct AFB colonies were observed on solid media and identified as Mycobacterium avium complex and Mycobacterium kansasii. Disseminated non-tuberculous mycobacterial infections involving two distinct species are rare, pose treatment challenges, and may correlate with cobimetinib administration for MDS, as well as GATA2 germline mutations.