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

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. We report the unusual case of a 44-year-old kidney transplant recipient with multiple pulmonary nodules revealing M. xenopi pulmonary disease with atypical presentation. A three drug-regimen containing moxifloxacin, ethambutol and azithromycin was prescribed, with careful monitoring of the immunosuppressive therapy. The outcome was favorable. 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 rifamycins require careful dose adjustment and monitoring to avoid graft rejection. •Mycobacterium xenopi is one of the most common pathogens responsible for non-tuberculosis mycobacteria (NTM) pulmonary diseases.•Clinicians should be aware of the risk of late pulmonary NTM infections and their atypical presentations among kidney transplant recipients.•Treatment relies on rifampicin, ethambutol and a macrolide but management of drug-drug interactions can be challenging in this population.