Infections may constitute a serious complication in patients with chronic lymphocytic\nleukemia (CLL). New treatment agents including obinutuzumab and ibrutinib have improved the\nprogression-free survival in CLL, and data suggest a similar overall infection risk and a limited risk\nof opportunistic infections when compared to standard chemo-immunotherapy. Nevertheless,\ncases of opportunistic infections including non-tuberculous mycobacterial (NTM) in CLL patients\nhave recently been published. We present a case of a 74-year old man with extensive prior CLL\ntreatment history, including most recently obinutuzumab. He developed an abscess of the psoas\nmuscle and inguinal lymphadenopathy. An inguinal node biopsy specimen showed infection with\nMycobacterium avium, confirmed by broad-spectrum mycobacterial PCR, M. avium-specific PCR,\nand mycobacterial culture. This case and our literature review suggest that physicians should be\naware of opportunistic infections in patients with CLL. Diagnostic differentiation from CLL disease\nprogression, Richterâ??s transformation to aggressive lymphoma, and secondary malignancy relies\non histological and appropriate microbiological studies from biopsy material of affected organs.\nInfection prophylaxis in CLL should be considered, including vaccinations and intravenous\nimmune globulin replacement.
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