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Eradication of Mycobacterium abscessus infection in cystic fibrosis with initiation of Elexacaftor/Tezacaftor/Ivacaftor

Mycobacterium abscessus is a nontuberculous mycobacterium that is often multi-drug resistant, difficult to eradicate and associated with a rapid decline in lung function in cystic fibrosis (CF). Elexacaftor/Tezacaftor/Ivacaftor (ETI) is a combination CFTR modulator that improves lung function and decreases exacerbations, but limited data exists about its impact on respiratory infections. A 23-year-old male with CF (F508del, unknown) was diagnosed with Mycobacterium abscessus subspecies abscessus infection. He completed 12-weeks of intensive therapy, followed by oral continuation therapy. Antimicrobials were later discontinued for optic neuritis secondary to linezolid. He remained off antimicrobials with persistently positive sputum cultures. He then initiated ETI, and bronchoscopy eight months later suggested eradication of M. abscessus. By modulating CFTR protein function, ETI may improve innate airway defence mechanisms, facilitating the clearance of infections such as M. abscessus. This case highlights the potential positive implications of ETI on the challenging treatment of M. abscessus infections in CF.

 

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It appears that the use of the CFTR modulator combination ETI may have had a positive impact on the eradication of M. abscessus in this patient with CF. While the precise mechanism behind this effect is not yet fully understood, it is possible that the improved airway clearance and innate immune function associated with ETI therapy played a role in facilitating the clearance of the infection.

It is important to note that this case is just one example, and further research will be necessary to determine the full extent of the impact of CFTR modulator therapy on respiratory infections in CF, including those caused by nontuberculous mycobacteria. Nonetheless, these findings suggest a potential avenue for improving the management of challenging infections like M. abscessus in CF, which could have significant implications for the long-term health outcomes of patients with this condition.

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