Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2022; 10(10): 3284-3290
Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3284
Mycobacterium tuberculosis bacteremia in a human immunodeficiency virus-negative patient with liver cirrhosis: A case report
Zhe-Zhe Lin, Dan Chen, Sai Liu, Jian-Hua Yu, Shou-Rong Liu, Ming-Li Zhu
Zhe-Zhe Lin, Dan Chen, Sai Liu, Ming-Li Zhu, Department of Open Laboratory Medicine, Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
Jian-Hua Yu, Department of Infectious Diseases, Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
Shou-Rong Liu, Department of Hepatology, Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
Author contributions: Lin ZZ and Chen D reviewed the literature and contributed to the manuscript draft; Liu S carried out the pathological analysis and interpretation; Yu JH and Liu SR analyzed and interpreted the image data; Zhu ML revised the manuscript for important intellectual content; all authors approved the final manuscript for submission.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and all accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming-Li Zhu, MMed, Chief Technician, Department of Open Laboratory Medicine, Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, No. 2 Hengbu Street, Hangzhou 310000, Zhejiang Province, China. mlzhhz@163.com
Received: November 23, 2021
Peer-review started: November 23, 2021
First decision: January 11, 2022
Revised: February 4, 2022
Accepted: February 23, 2022
Article in press: February 23, 2022
Published online: April 6, 2022
Processing time: 125 Days and 21.2 Hours
Abstract
BACKGROUND

With the increasing prevalence of human immunodeficiency virus (HIV), the incidence of Mycobacterium tuberculosis (M. tuberculosis) bacteremia has also increased. As a common affliction of acquired immunodeficiency syndrome patients, M. tuberculosis infection is associated in these patients with severe sepsis and high mortality. In contrast, M. tuberculosis bacteremia is rarely seen in HIV-negative patients, and M. tuberculosis has never been reported from the blood of patients with liver cirrhosis.

CASE SUMMARY

We evaluated a 55-year-old Chinese male patient who had been admitted to the hospital with abdominal distension of unknown cause of one-week duration, accompanied by diarrhea, shortness of breath, and occasional fever. Based on these indicators of abnormal inflammation and fever, we suspected the presence of an infection. Although evidence of microbial infection was not found in routine clinical tests and the patient did not show typical clinical symptoms of infection with M. tuberculosis, next-generation sequencing of blood samples nevertheless demonstrated the presence of M. tuberculosis, which was subsequently isolated from blood samples grown in conventional BacT/ALERT FA blood culture bottles.

CONCLUSION

Our findings demonstrate that HIV-negative liver cirrhosis patients can also be infected with M. tuberculosis.

Keywords: Mycobacterium tuberculosis; Bacteremia; Human immunodeficiency virus; Liver cirrhosis; High-throughput nucleotide sequencing; Case report

Core Tip: Our findings are interesting in two ways. First, although Mycobacterium tuberculosis (M. tuberculosis) bacteremia is a common occurrence in acquired immunodeficiency syndrome patients, it has rarely been reported from human immunodeficiency virus (HIV)-negative patients. We report here, however, a case of M. tuberculosis bacteremia in an HIV-negative patient diagnosed with liver cirrhosis. This finding should alert physicians to consider the possibility of M. tuberculosis bacteremia in patient populations not usually considered to be vulnerable to such infections. Second, our successful use of next-generation sequencing for detection of M. tuberculosis in the blood should be of interest to physicians as a tool for early detection of microbial infection.