Disseminated Mycobacterium abscessus lymphadenopathy in an anti-interferon-γ autoantibody syndrome patient treated with anti-NTM therapy combined with hemoadsorption: A case report.

BACKGROUND

Anti-interferon-γ autoantibody syndrome (AIGAs) is a primary immunodeficiency disorder characterized by neutralizing autoantibodies blocking interferon-γ signaling, predisposing patients to severe opportunistic infections. No definitive treatment protocol exists, and conventional therapies carry infection risks. Hemoadsorption (HA) is effective for autoimmune diseases but has not been specifically investigated for AIGAs.

CASE PRESENTATION: A 65-year-old Chinese female was admitted with 10-month painless disseminated lymphadenopathy. 18F-fluorodeoxyglucose positron emission tomography/computed tomography showed multiple hypermetabolic lymph nodes, and ultrasound-guided biopsy revealed necrotizing granulomatous inflammation. Metagenomic next-generation sequencing identified Mycobacterium abscessus, and enzyme-linked immunosorbent assay confirmed high AIGA levels (88.05% at 1:3200 dilution). She received anti-nontuberculous mycobacteria therapy (clarithromycin, minocycline, contezolid) combined with one HA session using a cytokine adsorption column. Post-treatment, AIGA levels normalized to 0% at 24 weeks and remained stable. 72-week follow-up showed resolved lymphadenopathy and reduced lymph node size/metabolic activity on PET/CT.

CONCLUSION

This is the first report of single-session HA for AIGAs complicated by disseminated M. abscessus infection. HA effectively reduced AIGA levels, controlled infection, and avoided global immunosuppression, providing a promising adjunctive therapy for AIGA patients with severe disseminated infections.