Mycobacterium xenopi infection in an immunocompromised liver transplant recipient: A case report and comprehensive review

Mycobacterium xenopi, a nontuberculous mycobacterium (NTM), presents a significant diagnostic challenge in clinical practice, particularly in immunocompromised individuals. We report a case of M. xenopi infection in a liver transplant recipient on immunosuppressive medication. A 67-year-old male presented with chronic cough, anemia, and significant weight loss. Imaging studies revealed extensive pulmonary involvement with cavitations. More definitively, an acid-fast bacilli (AFB) bronchoalveolar lavage culture as well as an acid-fast bacilli (AFB) sputum culture confirmed M. xenopi infection. Treatment initiation with multiple antimicrobial agents was guided by susceptibility testing and published recommendations by the Infectious Disease Society of America and the American Thoracic Society guidelines from 2020 (Kurz, et al., 2020). This case emphasizes the importance of considering non-tubercular bacterial infections, particularly M. xenopi, in the differential diagnosis of respiratory symptoms in immunocompromised hosts. In addition to the case report, this paper provides a comprehensive review of the epidemiology, risk factors, clinical manifestations, diagnostic challenges, and treatment strategies for M. xenopi infections.