We describe the first case report of pathology-proven brain infection by Mycobacterium chimaera (MC). A 35-year-old male, previously operated in 2010 of aortic valve and ascending aortic replacement, was addressed to our hospital for the acute onset of aphasia preceded by absence. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed multiple left frontal and temporal cortical-subcortical lesions. During hospitalization the patient never presented fever and cerebrospinal fluid (CSF), PCR, FilmArray and blood tests were within normal ranges. Transesophageal echocardiography showed no cardiac abnormalities. A thorax-abdomen CT scan was performed, revealing no extracranial abnormalities, and a whole body PET-CT scan showed a high uptake of brain lesions. Considering clinical results and the suspect of a tumoural lesion, the patient underwent surgery, where a left frontal enhanced nodular lesion was removed. Pathology finally revealed it was an abscess caused by Mycobacterium chimaera. This case confirms that Mycobacterium chimaera infection spread can be very subtle and diagnosis a real challenge, particularly years after surgery. We would like to underline the importance of suspecting an atypical infection source related to a history of cardiothoracic surgery, given a non-specific MR pattern and subtle clinical and laboratory findings.

中文翻译：

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Chimaera分支杆菌脑感染：一例报告

我们描述了由分枝杆菌分枝杆菌经病理证实的脑部感染的第一例报告（MC）。一名35岁的男性，曾在2010年进行过主动脉瓣手术并升主动脉置换手术，因失语先发急性失语症而先去我院诊治。计算机断层扫描（CT）和磁共振成像（MRI）显示了多个左额叶和颞叶皮质下皮质病变。住院期间，患者从未发烧，脑脊液（CSF），PCR，FilmArray和血液检查均在正常范围内。经食道超声心动图检查未发现心脏异常。进行了胸部-腹部CT扫描，未发现颅外异常，全身PET-CT扫描显示脑部病变被高摄取。考虑到临床结果和疑似肿瘤病变，患者接受了手术，切除了左额叶增强结节性病变。Chimaera分枝杆菌。该病例证实，分枝杆菌的感染传播可能非常微妙，诊断确实是一项挑战，特别是在手术后数年。考虑到非特异性MR模式以及微妙的临床和实验室发现，我们想强调怀疑与心胸外科手术史有关的非典型感染源的重要性。