Chronic Lymphocytic Lymphoma Complicated by Mycobacterium Avium and Scedosporium Apiospermum.

Abstract

Introduction: Chronic lymphocytic leukaemia (CLL), the most common adult leukaemia in Western countries, poses unique management challenges, particularly when complicated by opportunistic infections. This report presents a rare case of CLL with concurrent Mycobacterium avium and Scedosporium apiospermum infections-pathogens increasingly recognized for causing severe disease in immunocompromised individuals. Their coexistence highlights the need for heightened awareness of diverse infectious complications in CLL patients.

Case description: We present a case of a 78-year-old male with CLL receiving chemotherapy, who developed burning pain in the tongue and oral mucosa, accompanied by a non-productive cough. He was initially diagnosed with pneumonia, but further investigation revealed co-infection involving M. avium and S. apiospermum.

Discussion: The coexistence of M. avium and S. apiospermum underscores the complexity of infectious complications in CLL. The patient's chemotherapy was halted due to active pneumonitis observed on imaging in order to improve his leukocyte count. Antifungal therapy was not initiated due to a lack of evidence of invasive fungal infection. Antimycobacterial therapy for M. avium complex was initiated.

Conclusion: This case highlights the necessity of a multidisciplinary approach and continued research to optimize management strategies and improve outcomes in CLL patients with dual infections.

Learning points: A high index of suspicion is needed for rare infections, such as Mycobacterium avium and Scedosporium apiospermum, when typical symptoms are absent or mild in immunocompromised patients with chronic lymphocytic leukaemia.An individualized, evidence-based approach is needed in choosing the treatment for opportunistic organisms while withholding cancer therapy.