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<p>An 8-year-old spayed female American Shorthair cat was evaluated for refractory perioral nodules and respiratory distress persisting for 9 months. The patient had a history of feline atopy and chronic gingivostomatitis managed with long-term immunosuppressive therapy, including cyclosporine A and prednisolone. Pre-surgical computed tomography (CT) revealed a 2.1&#xa0;cm nasolabial mass without osteolysis, later diagnosed as a mycobacterial infection. This unusual infection was tentatively attributed to pharmacological suppression of cell-mediated immunity, potentially impairing both granuloma formation and inflammatory bone resorption. Fine-needle aspiration (FNA) and Ziehl–Neelsen (ZN) staining demonstrated a high burden of acid-fast bacilli (AFB). However, conventional cultures, including inoculation on 3% Ogawa medium, failed due to rapid overgrowth of <i>Klebsiella pneumoniae (K. pneumoniae)</i>. Post-mortem multi-target real-time PCR and whole genome sequencing (WGS), together with internal transcribed spacer (ITS) sequencing and phenotypic antimicrobial testing, identified a fatal co-infection comprising <i>Mycobacterium tuberculosis</i> complex (MTBC), <i>Mycobacterium kansasii</i>, <i>K. pneumoniae</i>, and multidrug-resistant <i>Pseudomonas aeruginosa</i>. This report describes a rare feline case of a fatal polymicrobial infection involving both MTBC and non-tuberculous mycobacteria (NTM) in conjunction with opportunistic gram-negative pathogens. The findings suggest that chronic iatrogenic immunosuppression may alter or obscure classical diagnostic features of mycobacteriosis and facilitate complex co-infections. This case highlights the importance of high-sensitivity molecular diagnostics and suggests that immunocompromised companion animals may, in rare instances, serve as cautious indicators of possible household mycobacterial exposure within a One Health framework.</p> Graphical abstract <p></p>

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Quadruple co-infection with Mycobacterium tuberculosis complex and M. kansasii in a chronically immunosuppressed cat

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月29日

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  • Sungyoung Choi,
  • Soo-Nyun Choi,
  • Tak Gyeom Lee,
  • Sungweon Ryoo,
  • Ji-Hoon Kwak,
  • Kun-Woo Kim,
  • Tae In Park,
  • Woo-Jin Song,
  • Eun-Joo Lee,
  • Kyu-Shik Jeong

摘要

An 8-year-old spayed female American Shorthair cat was evaluated for refractory perioral nodules and respiratory distress persisting for 9 months. The patient had a history of feline atopy and chronic gingivostomatitis managed with long-term immunosuppressive therapy, including cyclosporine A and prednisolone. Pre-surgical computed tomography (CT) revealed a 2.1 cm nasolabial mass without osteolysis, later diagnosed as a mycobacterial infection. This unusual infection was tentatively attributed to pharmacological suppression of cell-mediated immunity, potentially impairing both granuloma formation and inflammatory bone resorption. Fine-needle aspiration (FNA) and Ziehl–Neelsen (ZN) staining demonstrated a high burden of acid-fast bacilli (AFB). However, conventional cultures, including inoculation on 3% Ogawa medium, failed due to rapid overgrowth of Klebsiella pneumoniae (K. pneumoniae). Post-mortem multi-target real-time PCR and whole genome sequencing (WGS), together with internal transcribed spacer (ITS) sequencing and phenotypic antimicrobial testing, identified a fatal co-infection comprising Mycobacterium tuberculosis complex (MTBC), Mycobacterium kansasii, K. pneumoniae, and multidrug-resistant Pseudomonas aeruginosa. This report describes a rare feline case of a fatal polymicrobial infection involving both MTBC and non-tuberculous mycobacteria (NTM) in conjunction with opportunistic gram-negative pathogens. The findings suggest that chronic iatrogenic immunosuppression may alter or obscure classical diagnostic features of mycobacteriosis and facilitate complex co-infections. This case highlights the importance of high-sensitivity molecular diagnostics and suggests that immunocompromised companion animals may, in rare instances, serve as cautious indicators of possible household mycobacterial exposure within a One Health framework.

Graphical abstract