Disseminated Mycobacterium sherrisii infection in an Indian human immunodeficiency virus (HIV)-infected patient with immune reconstitution inflammatory syndrome (IRIS): a case report

Mycobacterial infections are a serious threat to human immunodeficiency virus (HIV) patients worldwide. There has been a steady increase in the diagnosis of non-tuberculous mycobacteria (NTM) infections over recent years, owing to advances and improved accessibility of molecular and genomic techniques. Mycobacterium sherrisii is a newly recognized species within the NTM group of organisms that causes disseminated infection in HIV patients. We report the first case of disseminated M. sherrisii infection in an HIV-infected patient from India. The patient, a 40-year-old male from Maharashtra state, Western India, was admitted to Poona Hospital with symptoms of generalized weakness, high-grade fever with chills, easy fatigability, abdominal pain, progressive abdominal distension, and multiple episodes of watery diarrhea for the past three months. The patient was diagnosed with HIV-1 infection with a low baseline CD4 count (65 cells/µL) and initiated simultaneously on antiretroviral therapy (ART) and empiric first-line 4-drug anti-tubercular therapy (ATT). After administration of both ART and ATT, the patient’s symptoms, especially fever, abdominal distension, and diarrhea worsened over the next three months. Post-admission, ascitic fluid and stool culture resulted in the growth of atypical mycobacteria. In addition, PCR analyses indicated the presence of NTM and the absence of Mycobacterium tuberculosis complex. Further confirmatory identification using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) confirmed the organism as M. sherrisii . The positive culture was processed to ascertain drug susceptibility profile. The patient was started on clarithromycin, ethambutol, and rifabutin based anti-mycobacterial therapy along with steroids for treatment of immune reconstitution inflammatory syndrome (IRIS); ART was continued. The clinical presentation of disseminated M. sherrisii infection is indistinguishable from that of M. tuberculosis . Timely initiation of appropriate macrolide-based therapy against the specific non-tuberculous mycobacterium is essential for improving patient outcomes. We exhibit the importance of rapid mycobacterial species identification and early definitive therapy in patients with advanced HIV disease.