Mycoplasma hominis hematoma infection in patient following kidney transplant

•Mycoplasma spp. can be involved in extragenital infections, primarily in immunosuppressed patients.•When an organism is not identified on Gram stain, consider M. hominis, especially in the setting of immunosuppression.•Post-transplant antimicrobial prophylaxis regimens often consist of beta-lactams which lack activity against Mycoplasma spp.•It is imperative to utilize Gram stain results to guide empiric therapy while awaiting culture. Mycoplasma species, specifically Mycoplasma hominis (M. hominis), are commonly associated with genitourinary (GU) tract infectious syndromes. However, Mycoplasma spp. can also be involved in extragenital infections, primarily in immunosuppressed patients. A 61 year old female was successfully treated with moxifloxacin and doxycycline combination therapy for an infected hematoma secondary to M. hominis following a renal transplant. Microbiology technologists noted the growth of pinpoint, translucent non-hemolytic colonies, but no organisms seen on Gram stain. These findings prompted the updated culture report of, “Growth on culture plates, gram stain suggestive of organism lacking cell wall.” Empiric antimicrobials were initiated to cover both Mycoplasma spp. and Ureaplasma spp before resulting M. hominis. Initiating empiric therapy directed against Mycoplasma spp. following Gram stain results and before organism speciation may prevent a lapse in effective therapy. This is especially important as perioperative antimicrobial prophylaxis regimens consist of beta-lactam regimens directed against common GI and GU pathogens, which lack activity against Mycoplasma spp.