A case of ascetic fluid Mycobacterium aubagnense infection in a patient with severe peritoneal effusion

Background: Mycobacterium aubagnense, which was first characterized in 2006, is a non-tuberculosis mycobacterium (NTM) that has only been isolated from respiratory secretions and joint fluid. With only four cases globally, the microbe has rarely been reported in human clinical cases and the strain has not been isolated from ascites.

Case presentation: To the best of our knowledge, this is the first time that M. aubagnense has been isolated from ascites samples of a patient with severe peritoneal effusion and normal liver functions. Anti-NTM therapy with moxifloxacin, ethambutol, and isoniazid combined with furosemide and spironolactone diuretic therapy relieved the symptoms after six months.

Conclusions: Increased puncture and drainage of ascites combined with diuretic treatment did not significantly relieve the ascites, leading to relapse with aggravated symptoms. The subsequent anti-NTM treatment with moxifloxacin, ethambutol, and isoniazid alleviated the degree of ascites. Therefore, we postulated that M. aubagnense infection was the potential cause of the difficult reduction of ascites in this patient. However, the ascites repeatedly occurred in the patient, which was attributed to M. aubagnense resistance due to insufficient medication time and repeated medication. The patient's underlying diseases may also result in ascites. Therefore, there is a need for careful analysis of the clinical significance of M. aubagnense.

Comments：

This is a case report describing the first instance of Mycobacterium aubagnense being isolated from ascites samples in a patient with severe peritoneal effusion. The patient was initially treated with puncture and drainage of ascites combined with diuretic therapy, but this did not significantly relieve the symptoms. Anti-NTM therapy with moxifloxacin, ethambutol, and isoniazid, combined with diuretic therapy, was then administered, leading to a reduction in the degree of ascites. However, the ascites later recurred, which was believed to be due to resistance from the M. aubagnense strain or due to the patient's underlying diseases.This case highlights the importance of careful analysis in determining the clinical significance of M. aubagnense, especially when it is isolated from a patient with severe peritoneal effusion. Further research is needed to better understand the potential causes of difficult reduction of ascites, and to determine effective treatment strategies for patients infected with M. aubagnense.

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