Disseminated infection caused by Mycobacterium sherrisii in an HIV-negative patient from China: A case report and literature review

<h2>Abstract</h2><h3>Background</h3> <i>:</i> It has been 20 years since the first identification of <i>Mycobacterium sherrisii</i> (<i>M. sherrisii</i>) in 2004. However, the rare and nonspecific clinical infection cases of this bacterium have not been well summarized and systematically analyzed, posing significant challenges to the diagnosis and treatment of <i>M. sherrisii</i> infection. <h3>Case presentation</h3> <i>:</i> We detail the case of a 54-year-old HIV-negative Chinese female who presented with systemic symptoms including fatigue, recurrent fever and diffuse bone pain, initially raising suspicion for malignancy. She had undergone right-sided cervical acupuncture, followed by persistent lymphadenopathy with subcutaneous emphysema. Imaging revealed multiorgan involvement, including lymph nodes, esophagus, lung, heart and bones. Following the detection of acid-fast bacilli in lymph node and bone marrow specimens by fluorescent staining, isolates obtained from pericardial effusion, sputum and pleural fluid culture were ultimately identified as <i>M. sherrisii</i> through <i>hsp65</i> gene and whole-genome sequencing, further confirming its genetic stability. After a full year of treatment based on drug susceptibility testing results, she was successfully treated and has had no recurrence. <h3>Conclusions</h3> <i>:</i> This case highlights the diagnostic challenge of an atypical disseminated <i>M. sherrisii</i> infection in non-HIV patient, with acupuncture identified as the probable portal of entry. Successful management requires individualized therapy based on drug susceptibility testing results. Furthermore, we review 26 published cases (including this study) to better characterize the epidemiology and clinical features of this rare species.