Atypical presentation of Mycobacterium xenopi pulmonary infection in a kidney transplant recipient: A case report and literature review

Background: Mycobacterium xenopi is one of the most common pathogens responsible for non-tuberculosis mycobacteria (NTM) pulmonary diseases, which are associated with poor prognosis in immunocompromised patients.Case presentation: We report the unusual case of a 44-year-old kidney transplant recipient with multiple pul-monary nodules revealing M. xenopi pulmonary disease with atypical presentation. A three drug-regimen con-taining moxifloxacin, ethambutol and azithromycin was prescribed, with careful monitoring of the immunosuppressive therapy. The outcome was favorable. Discussion and conclusion: Although infrequent in kidney transplant recipients, NTM can cause pulmonary infection several years after transplantation. Treatment of M. xenopi infection relies on a multidrug regimen with at least 3 antimycobacterial drugs. Drug-drug interactions between immunosuppressive treatments and rifa-mycins require careful dose adjustment and monitoring to avoid graft rejection.