Metagenomic next-generation sequencing identifying a rare case of Mycobacterium xenopi discitis

• Published in: BMJ case reports Vol. 16; no. 11; p. e255594
• Main Authors: Nasir, Ali Zagham, Egwuatu, Nnaemeka, Jameson, Andrew
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 09.11.2023
• Subjects: Abscesses; Antibiotics; Back pain; Back surgery; Bacterial infections; Case reports; Chemotherapy; Consent; Discitis - diagnosis; Discitis - drug therapy; Discitis - microbiology; Edema; Ethambutol; Female; High-Throughput Nucleotide Sequencing; Humans; Infections; Infectious diseases; Laparoscopy; Lymphoma; Middle Aged; Mycobacterium; Mycobacterium Infections, Nontuberculous - diagnosis; Mycobacterium Infections, Nontuberculous - drug therapy; Mycobacterium Infections, Nontuberculous - microbiology; Mycobacterium xenopi - genetics; Pathogens; Infectious diseases; Medical management; Bone and joint infections; Rheumatology; Orthopaedics
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2023-255594

is a non-tuberculous mycobacterium (NTM) that sporadically causes infections in humans and can cause rare bone and joint infections in immunocompromised hosts with history of spinal surgery. This slow-growing mycobacterium takes 8-12 weeks to grow on culture. Metagenomic next-generation sequencing (MNGS) is a highly sensitive and specific plasma-based microbial cell-free DNA test that can detect weeks prior to culture growth. We present a case of lumbosacral discitis with presacral abscess in an immunocompromised woman without history of spinal surgery which was detected by MNGS 8 weeks prior to culture growth. The patient's discitis resolved with an -directed regimen of ethambutol, rifampin and azithromycin. This case illustrates the utility of next-generation sequencing tests in rapid diagnosis of rare and opportunistic infections, as compared with traditional diagnostic tests, with supporting contextual clinical and diagnostic findings.