To the Editor: A strain of My-cobacterium massiliense was isolated from the blood of a kidney transplant patient in Italy at the same time she was diagnosed as having pulmonary tuberculosis. M. massiliense bacter-emia appears to have played a role in her sudden death.The patient, a 63-year-old wom-an who had had a kidney transplant 10 years earlier and was receiving immunosuppressive treatment with cyclosporine, azathioprine, and pred-nisolone, was hospitalized in an inten-sive care unit because of septic shock, a stuporous condition, hypotension, respiratory insuffi ciency, and acute renal failure. Results of initial micro-biologic investigations (cultures of blood, urine, and bronchial aspirate, and nasal and pharyngeal swabs; tests for antigens of Legionella pneumophi-la, pneumococcus, and Cryptococcus neoformans; and serologic analysis for pneumotropic viruses and bacte-ria) were negative. Hematologic analysis showed leukopenia with high neutrophil counts. Septic shock–specifi c therapy was given along with wide-spectrum antimicrobial drug therapy (levo. oxa-cin, trimethoprim-sulfamethoxazole, piperacillin-tazobactam, and . ucon-azole). After moderate improvement, the patient's general condition wors-ened and prompted a new round of mi-crobiologic tests, including those for mycobacteria. After acid-fast bacilli were detected in a bronchial aspirate and results of nucleic acid amplifi ca-tion (Amplicor; Roche, Basel, Swit-zerland) were positive for M. tubercu-losis complex, she was given standard antituberculosis treatment. She died the next day. Three blood cultures obtained 7 days before the death of the patient showed positive results in aerobic bot-tles but not in anaerobic bottles (BacT/ALERT SA; bioMérieux, Marcy l'Etoile, France). Subcultures spread onto blood agar yielded small white colonies of gram-positive bacilli, in-cluding branched forms, within 24 hours. One month earlier, the patient had been seen as an outpatient with intermittent fever, and unidentifi ed gram-positive bacilli were observed in her blood culture
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