{"title":"Disseminated Mycobacterium tuberculosis from Infected Bone Graft Source: Case Study in Iatrogenic Infection and Our Approach.","authors":"Thomas Herb, Jeffrey Jentzen, Carl Schmidt","doi":"10.1097/PAF.0000000000001027","DOIUrl":null,"url":null,"abstract":"<p><strong>Abstract: </strong>Iatrogenic infections of cadaveric bone grafts have led to 2 outbreaks of Mycobacterium tuberculosis (Mtb) infection in the United States that have resulted in multiple fatalities. We report a case of one of the bone graft recipients from the 2023 outbreak. A 57-year-old immunocompromised female with a history of renal failure status post 3 kidney transplants underwent a laminectomy with a cadaveric bone graft due to spinal stenosis. She was later hospitalized with diffuse lymphadenopathy and surgical site purulent ulceration. The workup included positive cultures for Mtb. Despite appropriate therapy, the patient died in the hospital. Autopsy findings included purulent discharge from the surgical site, medullary abscesses of one of the transplanted kidneys, diffuse pinpoint areas of softening in the liver, and lung congestion. Histology of the liver and right lung demonstrated loose granulomas with abundant acid-fast organisms. The kidney abscesses were due to Candida species infection. Overall, findings were consistent with disseminated Mtb infection. Additional investigation found similar infections in recipients of the same bone graft source. We compare the Mtb outbreaks to similar outbreaks, including cases of fungal meningitis due to steroid injections, and discuss our approach and strategy in cases of iatrogenic infection.</p>","PeriodicalId":55535,"journal":{"name":"American Journal of Forensic Medicine and Pathology","volume":" ","pages":""},"PeriodicalIF":1.0000,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Forensic Medicine and Pathology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PAF.0000000000001027","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"MEDICINE, LEGAL","Score":null,"Total":0}
引用次数: 0
Abstract
Abstract: Iatrogenic infections of cadaveric bone grafts have led to 2 outbreaks of Mycobacterium tuberculosis (Mtb) infection in the United States that have resulted in multiple fatalities. We report a case of one of the bone graft recipients from the 2023 outbreak. A 57-year-old immunocompromised female with a history of renal failure status post 3 kidney transplants underwent a laminectomy with a cadaveric bone graft due to spinal stenosis. She was later hospitalized with diffuse lymphadenopathy and surgical site purulent ulceration. The workup included positive cultures for Mtb. Despite appropriate therapy, the patient died in the hospital. Autopsy findings included purulent discharge from the surgical site, medullary abscesses of one of the transplanted kidneys, diffuse pinpoint areas of softening in the liver, and lung congestion. Histology of the liver and right lung demonstrated loose granulomas with abundant acid-fast organisms. The kidney abscesses were due to Candida species infection. Overall, findings were consistent with disseminated Mtb infection. Additional investigation found similar infections in recipients of the same bone graft source. We compare the Mtb outbreaks to similar outbreaks, including cases of fungal meningitis due to steroid injections, and discuss our approach and strategy in cases of iatrogenic infection.
期刊介绍:
Drawing on the expertise of leading forensic pathologists, lawyers, and criminologists, The American Journal of Forensic Medicine and Pathology presents up-to-date coverage of forensic medical practices worldwide. Each issue of the journal features original articles on new examination and documentation procedures.
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