Abstract: FR-PO0464
A Case Report of Necrotizing Interstitial Nephritis from Mycobacterium chimaera Leads to ESRD
Session Information
- AKI: Case Reports - TMA, Vasculitis, Immune-Mediated Injury, and Systemic Disease
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Gupta, Uma Datta, Boston Medical Center, Boston, Massachusetts, United States
- Bonegio, Ramon, Boston Medical Center, Boston, Massachusetts, United States
- Rizzolo, Katherine M., Boston Medical Center, Boston, Massachusetts, United States
Introduction
The reported incidence of non-tuberculous mycobacterial (NTM) infections has increased in recent years, with growing recognition of cases involving multisystem organ involvement.
Case Description
We presented a 72-year-old man with newly recognized CKD stage IV, severe emphysematous COPD with chronic hypoxic respiratory failure, and a prior pulmonary non-tuberculous mycobacterial infection treated in 2015, who presented with AKI after outpatient labs showed worsening renal function, with all serologies negative, and was admitted for renal biopsy. Renal biopsy ultimately demonstrated necrotizing granulomatous interstitial nephritis with relative sparing of the glomeruli, raising strong concern for an underlying infectious etiology, particularly mycobacterial infection. Given his prior and recent respiratory cultures growing Mycobacterium chimaera, disseminated non-tuberculous mycobacterial infection involving the kidneys was felt to be the most likely unifying diagnosis, despite the absence of overt systemic immunosuppression or prior cardiothoracic surgery. While pulmonary NTM infections rarely disseminate in immunocompetent hosts, the biopsy findings and progressive renal dysfunction were considered highly consistent with renal involvement from M. chimaera. Within four months, his kidney function progressed to ESRD despite steroid therapy, which had been planned after two months of antimicrobial treatment following diagnosis. After progression to CKD stage V, he was transitioned to comfort measures only.
Discussion
To our knowledge, this represents one of the first reported cases of presumed disseminated M. chimaera infection causing multiorgan dysfunction in the absence of classic risk factors such as prior cardiac surgery or cystic fibrosis. While isolated reports have suggested possible benefits of corticosteroid therapy in granulomatous interstitial nephritis, particularly earlier in the disease course, immunosuppression in the setting of active mycobacterial infection remains controversial and may potentially worsen outcomes. We present this case to emphasize the diagnostic complexity, evolving disease trajectory, and potential consequences of delayed recognition of disseminated NTM infection