Main Article Content
Abstract
Les infections mammaires à Corynebacterium amycolatum, bien que rares, représentent un défi clinique croissant chez les patientes immunodéprimées. Deuxième espèce la plus fréquente après C. kroppenstedtii, sa multirésistance aux antibiotiques et l'absence de protocoles consensuels compliquent la prise en charge. Nous présentons le cas d’une patiente de 28 ans, sous chimiothérapie de seconde ligne (docétaxel-trastuzumab) pour cancer du sein droit avancé, reçue pour un syndrome inflammatoire systémique et un abcès mammaire fébrile 7 jours après sa cure. Le bilan a révélé une neutropénie fébrile avec isolement de C. amycolatum dans le pus (sensibilité à la vancomycine, ciprofloxacine, rifampicine et tétracyclines). La patiente a été perdue de vue après une semaine d'antibiothérapie adaptée. Ce premier cas camerounais illustre le risque méconnu des corynébactéries dans les abcès mammaires des patientes cancéreuses, l'urgence d'algorithmes diagnostiques incluant les cultures spécifiques (souvent négligées) et la nécessité d'une approche multidisciplinaire (oncologie-infectiologie) face aux profils de résistance complexes. Il alerte sur le sous-diagnostic de ces infections dans nos contextes à ressources limitées.
ABSTRACT
Although rare, breast infections with Corynebacterium amycolatum represent a growing clinical challenge in immunocompromised patients. Corynebacterium amycolatum is the second most common species after C. kroppenstedtii, and its multiple antibiotic resistance and lack of consensus protocols complicate its management. We present the case of a 28-year-old patient undergoing second-line chemotherapy (docetaxel-trastuzumab) for advanced right breast cancer, who presented with a systemic inflammatory syndrome and a febrile breast abscess 7 days after treatment. The work-up revealed febrile neutropenia with isolation of C. amycolatum in the pus (sensitive to vancomycin, ciprofloxacin, rifampicin and tetracyclines). The patient was lost to follow-up after a week of appropriate antibiotic therapy. This first case from Cameroon illustrates the little-known risk of corynebacteria in breast abscesses in cancer patients, the urgent need for diagnostic algorithms that include specific cultures (often neglected), and the need for a multidisciplinary approach (oncology-infectiology) in the face of complex resistance profiles. It warns of the under-diagnosis of these infections in our resource-limited environments.
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References
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- 2. Bernard K. The genus corynebacterium and other medically relevant coryneform-like bacteria. J Clin Microbiol. 2012 Oct;50(10):3152–8.
- 3. Hahn WO, Werth BJ, Butler-Wu SM, Rakita RM. Multidrug-Resistant Corynebacterium striatum Associated with Increased Use of Parenteral Antimicrobial Drugs. Emerg Infect Dis. 2016 Nov;22(11):1908–14.
- 4. Crum-Cianflone NF, Ballon-Landa G, Zorn G. Photo Quiz. Recurrent breast abscess in a 33-year-old woman. Clin Infect Dis Off Publ Infect Dis Soc Am. 2014 Aug 1;59(3):410; 454–5.
- 5. Taylor GB, Paviour SD, Musaad S, Jones WO, Holland DJ. A clinicopathological review of 34 cases of inflammatory breast disease showing an association between corynebacteria infection and granulomatous mastitis. Pathology (Phila). 2003 Apr;35(2):109–19.
- 6. Sun W, Ma L, Li Y, Xu Y, Wei J, Sa L, et al. In vitro Studies of Non-Diphtheriae Corynebacterium Isolates on Antimicrobial Susceptibilities, Drug Resistance Mechanisms, and Biofilm Formation Capabilities. Infect Drug Resist. 2022;15:4347–59.
- 7. Bernard K, Pacheco AL. In Vitro Activity of 22 Antimicrobial Agents against Corynebacterium and Microbacterium Species Referred to the Canadian National Microbiology Laboratory. Clin Microbiol Newsl [Internet]. 2015 Dec [cited 2025 May 19];37(23):187–98. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0196439915000902
- 8. Martins C, Faria L, Souza M, Camello T, Velasco E, Hirata R, et al. Microbiological and host features associated with corynebacteriosis in cancer patients: a five-year study. Mem Inst Oswaldo Cruz. 2009 Sep;104(6):905–13.
- 9. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer Oxf Engl 1990. 2009 Jan;45(2):228–47.
- 10. Paviour S, Musaad S, Roberts S, Taylor G, Taylor S, Shore K, et al. Corynebacterium species isolated from patients with mastitis. Clin Infect Dis Off Publ Infect Dis Soc Am. 2002 Dec 1;35(11):1434–40.
- 11. Dobinson HC, Anderson TP, Chambers ST, Doogue MP, Seaward L, Werno AM. Antimicrobial Treatment Options for Granulomatous Mastitis Caused by Corynebacterium Species. J Clin Microbiol. 2015 Sep;53(9):2895–9.
- 12. Szemraj M, Kwaszewska A, Pawlak R, Szewczyk EM. Macrolide, lincosamide, and streptogramin B resistance in lipophilic Corynebacteria inhabiting healthy human skin. Microb Drug Resist Larchmt N. 2014 Oct;20(5):404–9.
- 13. Reddy BS, Chaudhury A, Kalawat U, Jayaprada R, Reddy G, Ramana BV. Isolation, speciation, and antibiogram of clinically relevant non-diphtherial Corynebacteria (Diphtheroids). Indian J Med Microbiol. 2012;30(1):52–7.
- 14. Soltan Mohammadi N, Mafakheri S, Abdali N, Bárcena-Uribarri I, Tauch A, Benz R. Identification and characterization of the channel-forming protein in the cell wall of Corynebacterium amycolatum. Biochim Biophys Acta. 2013 Nov;1828(11):2574–82.
- 15. Carvalho RV de, Lima FF da S, Santos CSD, Souza MC de, Silva RS da, Mattos-Guaraldi AL de. Central venous catheter-related infections caused by Corynebacterium amycolatum and other multiresistant non-diphtherial corynebacteria in paediatric oncology patients. Braz J Infect Dis Off Publ Braz Soc Infect Dis. 2018;22(4):347–51.
- 16. Sengupta M, Naina P, Balaji V, Anandan S. Corynebacterium amycolatum: An Unexpected Pathogen in the Ear. J Clin Diagn Res JCDR. 2015 Dec;9(12):DD01-03.
- 17. Sugumaran R, Sistla S, Chavhan P, Deb AK. Corynebacterium amycolatum: an unusual cause of corneal ulcer. BMJ Case Rep. 2020 Dec 13;13(12):e237818.
- 18. Borde K, Rao V, Shah M, Pavani N, Anand M. Not always a commensal: A case of mastitis by Corynebacterium amycolatum. IDCases. 2020;20:e00728.
- 19. Shintani Y, Fukushima-Nomura A, Funakoshi T, Sakurai M, Kato J, Fukuyama M, et al. Multiple subcutaneous abscesses by Corynebacterium amycolatum in a patient with severe idiopathic aplastic anaemia. Skin Health Dis. 2024 Jun;4(3):e351.
- 20. Özaydin İs, Yildirim M, Şahi̇N İd, Doğan S. Recurrent Breast Abscess Caused by Corynebacterium amycolatum and Rewiev of the Literature. Turk J Med Sci [Internet]. 2009 Jan 1 [cited 2025 May 19];39(1):147–9. Available from: https://journals.tubitak.gov.tr/medical/vol39/iss1/25
- 21. Adil FZ, Aragon I, Benaissa E, Ben Lahlou Y, Bssaibis F, Maleb A, et al. Corynebacterium amycolatum peritonitis in a patient undergoing peritoneal dialysis: case report and literature review. Access Microbiol. 2024;6(10):000880.v3.
- 22. Butta H, Pasha F, Dawar R, Kashyap V, Mendiratta L, Bora U, et al. Corynebacteriumamycolatum causing breast abscess: An infecting Diphtheroid with a difference. Ann Pathol Lab Med [Internet]. 2017 Aug 25 [cited 2025 May 19];4(4):C128–30. Available from: https://www.pacificejournals.com/journal/index.php/apalm/article/view/apalm1456
- 23. Kumari P, Levy CS, McHenry KS, Fedorko D, Lucey DR. C. amycolatum: A Novel Cause of Breast Abscess: Infect Dis Clin Pract [Internet]. 2000 May [cited 2025 May 19];9(4):179–81. Available from: http://journals.lww.com/00019048-200009040-00009
- 24. Bahadir Z, Kalkan NB, Yilmaz M. A Case of Granulomatous Mastitis due to Corynebacterium amycolatum. Mediterr J Infect Microbes Antimicrob [Internet]. 2021 Aug 16 [cited 2025 May 19]; Available from: https://mjima.org/articles/doi/mjima.galenos.2021.2021.39
- 25. Lu C, Marcucci V, Kibbe E, Patel R. Granulomatous mastitis secondary to Corynebacterium requiring surgical intervention: a complicated diagnosis. J Surg Case Rep [Internet]. 2023 Apr 1 [cited 2025 May 19];2023(4):rjad211. Available from: https://academic.oup.com/jscr/article/doi/10.1093/jscr/rjad211/7136618
- 26. Jesus HNR, Rocha DJPG, Ramos RTJ, Silva A, Brenig B, Góes-Neto A, et al. Pan-genomic analysis of Corynebacterium amycolatum gives insights into molecular mechanisms underpinning the transition to a pathogenic phenotype. Front Microbiol. 2022;13:1011578.
References
1. Neemuchwala A, Soares D, Ravirajan V, Marchand-Austin A, Kus JV, Patel SN. In Vitro Antibiotic Susceptibility Pattern of Non-diphtheriae Corynebacterium Isolates in Ontario, Canada, from 2011 to 2016. Antimicrob Agents Chemother. 2018 Apr;62(4):e01776-17.
2. Bernard K. The genus corynebacterium and other medically relevant coryneform-like bacteria. J Clin Microbiol. 2012 Oct;50(10):3152–8.
3. Hahn WO, Werth BJ, Butler-Wu SM, Rakita RM. Multidrug-Resistant Corynebacterium striatum Associated with Increased Use of Parenteral Antimicrobial Drugs. Emerg Infect Dis. 2016 Nov;22(11):1908–14.
4. Crum-Cianflone NF, Ballon-Landa G, Zorn G. Photo Quiz. Recurrent breast abscess in a 33-year-old woman. Clin Infect Dis Off Publ Infect Dis Soc Am. 2014 Aug 1;59(3):410; 454–5.
5. Taylor GB, Paviour SD, Musaad S, Jones WO, Holland DJ. A clinicopathological review of 34 cases of inflammatory breast disease showing an association between corynebacteria infection and granulomatous mastitis. Pathology (Phila). 2003 Apr;35(2):109–19.
6. Sun W, Ma L, Li Y, Xu Y, Wei J, Sa L, et al. In vitro Studies of Non-Diphtheriae Corynebacterium Isolates on Antimicrobial Susceptibilities, Drug Resistance Mechanisms, and Biofilm Formation Capabilities. Infect Drug Resist. 2022;15:4347–59.
7. Bernard K, Pacheco AL. In Vitro Activity of 22 Antimicrobial Agents against Corynebacterium and Microbacterium Species Referred to the Canadian National Microbiology Laboratory. Clin Microbiol Newsl [Internet]. 2015 Dec [cited 2025 May 19];37(23):187–98. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0196439915000902
8. Martins C, Faria L, Souza M, Camello T, Velasco E, Hirata R, et al. Microbiological and host features associated with corynebacteriosis in cancer patients: a five-year study. Mem Inst Oswaldo Cruz. 2009 Sep;104(6):905–13.
9. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer Oxf Engl 1990. 2009 Jan;45(2):228–47.
10. Paviour S, Musaad S, Roberts S, Taylor G, Taylor S, Shore K, et al. Corynebacterium species isolated from patients with mastitis. Clin Infect Dis Off Publ Infect Dis Soc Am. 2002 Dec 1;35(11):1434–40.
11. Dobinson HC, Anderson TP, Chambers ST, Doogue MP, Seaward L, Werno AM. Antimicrobial Treatment Options for Granulomatous Mastitis Caused by Corynebacterium Species. J Clin Microbiol. 2015 Sep;53(9):2895–9.
12. Szemraj M, Kwaszewska A, Pawlak R, Szewczyk EM. Macrolide, lincosamide, and streptogramin B resistance in lipophilic Corynebacteria inhabiting healthy human skin. Microb Drug Resist Larchmt N. 2014 Oct;20(5):404–9.
13. Reddy BS, Chaudhury A, Kalawat U, Jayaprada R, Reddy G, Ramana BV. Isolation, speciation, and antibiogram of clinically relevant non-diphtherial Corynebacteria (Diphtheroids). Indian J Med Microbiol. 2012;30(1):52–7.
14. Soltan Mohammadi N, Mafakheri S, Abdali N, Bárcena-Uribarri I, Tauch A, Benz R. Identification and characterization of the channel-forming protein in the cell wall of Corynebacterium amycolatum. Biochim Biophys Acta. 2013 Nov;1828(11):2574–82.
15. Carvalho RV de, Lima FF da S, Santos CSD, Souza MC de, Silva RS da, Mattos-Guaraldi AL de. Central venous catheter-related infections caused by Corynebacterium amycolatum and other multiresistant non-diphtherial corynebacteria in paediatric oncology patients. Braz J Infect Dis Off Publ Braz Soc Infect Dis. 2018;22(4):347–51.
16. Sengupta M, Naina P, Balaji V, Anandan S. Corynebacterium amycolatum: An Unexpected Pathogen in the Ear. J Clin Diagn Res JCDR. 2015 Dec;9(12):DD01-03.
17. Sugumaran R, Sistla S, Chavhan P, Deb AK. Corynebacterium amycolatum: an unusual cause of corneal ulcer. BMJ Case Rep. 2020 Dec 13;13(12):e237818.
18. Borde K, Rao V, Shah M, Pavani N, Anand M. Not always a commensal: A case of mastitis by Corynebacterium amycolatum. IDCases. 2020;20:e00728.
19. Shintani Y, Fukushima-Nomura A, Funakoshi T, Sakurai M, Kato J, Fukuyama M, et al. Multiple subcutaneous abscesses by Corynebacterium amycolatum in a patient with severe idiopathic aplastic anaemia. Skin Health Dis. 2024 Jun;4(3):e351.
20. Özaydin İs, Yildirim M, Şahi̇N İd, Doğan S. Recurrent Breast Abscess Caused by Corynebacterium amycolatum and Rewiev of the Literature. Turk J Med Sci [Internet]. 2009 Jan 1 [cited 2025 May 19];39(1):147–9. Available from: https://journals.tubitak.gov.tr/medical/vol39/iss1/25
21. Adil FZ, Aragon I, Benaissa E, Ben Lahlou Y, Bssaibis F, Maleb A, et al. Corynebacterium amycolatum peritonitis in a patient undergoing peritoneal dialysis: case report and literature review. Access Microbiol. 2024;6(10):000880.v3.
22. Butta H, Pasha F, Dawar R, Kashyap V, Mendiratta L, Bora U, et al. Corynebacteriumamycolatum causing breast abscess: An infecting Diphtheroid with a difference. Ann Pathol Lab Med [Internet]. 2017 Aug 25 [cited 2025 May 19];4(4):C128–30. Available from: https://www.pacificejournals.com/journal/index.php/apalm/article/view/apalm1456
23. Kumari P, Levy CS, McHenry KS, Fedorko D, Lucey DR. C. amycolatum: A Novel Cause of Breast Abscess: Infect Dis Clin Pract [Internet]. 2000 May [cited 2025 May 19];9(4):179–81. Available from: http://journals.lww.com/00019048-200009040-00009
24. Bahadir Z, Kalkan NB, Yilmaz M. A Case of Granulomatous Mastitis due to Corynebacterium amycolatum. Mediterr J Infect Microbes Antimicrob [Internet]. 2021 Aug 16 [cited 2025 May 19]; Available from: https://mjima.org/articles/doi/mjima.galenos.2021.2021.39
25. Lu C, Marcucci V, Kibbe E, Patel R. Granulomatous mastitis secondary to Corynebacterium requiring surgical intervention: a complicated diagnosis. J Surg Case Rep [Internet]. 2023 Apr 1 [cited 2025 May 19];2023(4):rjad211. Available from: https://academic.oup.com/jscr/article/doi/10.1093/jscr/rjad211/7136618
26. Jesus HNR, Rocha DJPG, Ramos RTJ, Silva A, Brenig B, Góes-Neto A, et al. Pan-genomic analysis of Corynebacterium amycolatum gives insights into molecular mechanisms underpinning the transition to a pathogenic phenotype. Front Microbiol. 2022;13:1011578.