Case report Mycobacterium abscessus infection in solid organ transplant recipients: report of three cases and review of the literature A.P. Garrison 1 *, M.I. Morris 1 , S. Doblecki Lewis 1 , L. Smith 2 , T.J. Cleary 3 , G.W. Procop 4 , V. Vincek 5 , I. Rosa-Cunha 1 , B. Alfonso 6 , G.W. Burke 7 , A. Tzakis 7 , A.I. Hartstein 1w 1 Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA, 2 Pharmacy Services, Jackson Memorial Hospital, Miami, Florida, USA, 3 Clinical Microbiology and Pathology, University of Miami Miller School of Medicine, Miami, Florida, USA, 4 Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA, 5 Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida, USA, 6 Infection Prevention and Control, University of Miami Hospital, Miami, Florida, USA, 7 Transplant Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA A.P. Garrison, M.I. Morris, S. Doblecki Lewis, L. Smith,T.J. Cleary, G.W. Procop,V.V|ncek, I. Rosa-Cunha, B. Alfonso, G.W. Burke, A.Tzakis, A.I. Hartstein. Mycobacterium abscessus infection in solid organ transplant recipients: report of three cases and review of the literature. Transpl Infect Dis 2009: 11: 541^548. All rights reserved Abstract: Mycobacterium abscessus is an ubiquitous organism found in the environment.This rapidly growing mycobacterium infrequently causes disease in humans; however, in immunocompromised hosts, disease can range from localized cutaneous lesions to disseminated infection.The organism is resistant to most antimycobacterial drugs and therapy can be limited by drug interactions.The exact incidence of M. abscessus infection among solid organ transplant (SOT) recipients is unknown; data are only available from previously reported cases in the literature.We describe 3 cases of M. abscessus infection in SOT recipients diagnosed within a 5-month period. One of the cases followed multi-visceral transplantation, the ¢rst such case to be reported in the literature. An epidemiological investigation did not reveal signi¢cant commonalities among the cases, and pulsed-¢eld gel electrophoresis of genomic DNA of the case isolates con¢rmed their non-identity. All cases improved with antibiotic therapy, most notably with the new glycylcycline, tigecycline, along with surgical intervention in 2 of the cases. In addition, we review features and characteristics of M. abscessus infections in recipients of SOT reported in the literature from 1992 to 2008 and summarize some selected therapeutic concerns and issues related to treatment.                                                                                                                               Mycobacterium abscessus is a ubiquitous organism found in the environment in water, soil, and dust. It may also colo- nize skin surfaces and secretions of the respiratory and gastrointestinal tracts in humans (1, 2). Disease due to non-tuberculous mycobacterium (NTM) has increased in solid organ transplant (SOT) recipients.This increase may be the result of increased frequency of transplants, longer recipient survival, more potent immunosuppressive regi- mens, or improved diagnostic procedures (3).The true inci- dence of M. abscessus and other NTM infections is unknown.We report a cluster of 3 cases of SOT recipients diagnosed with M. abscessus infections within a 5-month period from November 2006 to April 2007 at a tertiary-care university transplant center in Florida. In our cluster of r 2009 John Wiley & Sons A/S Transplant Infectious Disease . ISSN 1398-2273 Key words: Mycobacterium abscessus; transplantation; immunosuppression; tigecycline; drug interactions Correspondence to: Michele I. Morris, MD, Division of Infectious Diseases, University of Miami Miller School of Medicine, 1400 NW 10th Avenue, Suite 812 (D90A), Miami, FL 33136, USA Tel: 1 1 305 243 4598 Fax: 1 1 305 243 4037 E-mail: mmorris2@med.miami.edu *Dr Garrison completed her Infectious Diseases fellowship and is now in practice in Jamaica. w Dr Hartstein has retired from the University of Miami. Received 23 March 2009, revised 10 May 2009, accepted for publication 14 June 2009 DOI: 10.1111/j.1399-3062.2009.00434.x Transpl Infect Dis 2009: 11: 541–548 541