Korean J Lab Med.  2010 Apr;30(2):166-170. 10.3343/kjlm.2010.30.2.166.

Disseminated Mycobacterium avium Complex Infection in a Non-HIV-infected Patient Undergoing Continuous Ambulatory Peritoneal Dialysis

• Chung JW
• Cha YJ
• Oh DJ
• Nam WJ
• Kim SH
• Lee MK
• Kim HR

• KMID: 1096803
• DOI: http://doi.org/10.3343/kjlm.2010.30.2.166

Abstract

Isolated bone marrow infection by nontuberculous mycobacteria (NTM) is extremely rare. Recently, we encountered a case of bone marrow Mycobacterium avium complex (MAC) infection, which presented as a fever of unknown origin shortly after starting continuous ambulatory peritoneal dialysis (CAPD). The patient was diagnosed with MAC infection on the basis of PCR-restriction fragment length polymorphism analysis and sequencing of DNA obtained from bone marrow specimens. Although this was a case of severe MAC infection, there was no evidence of infection of other organs. End-stage renal disease (ESRD) patients undergoing dialysis can be considered immunodeficient; therefore, when these patients present with fever of unknown origin, opportunistic infections such as NTM infection should be considered in the differential diagnosis.

Keyword

End-stage renal disease; Mycobacterium avium complex; Bone marrow

MeSH Terms

Aged
Anti-Bacterial Agents/therapeutic use
Bacterial Proteins/genetics
Bone Marrow/microbiology/pathology
Diagnosis, Differential
Female
HIV Infections/diagnosis
Humans
Kidney Failure, Chronic/therapy
*Mycobacterium avium Complex/genetics/isolation &purification
Mycobacterium avium-intracellulare Infection/*diagnosis/drug therapy/microbiology
*Peritoneal Dialysis, Continuous Ambulatory
Polymerase Chain Reaction
Polymorphism, Restriction Fragment Length
Sequence Analysis, DNA

Figure

• 

  Fig. 1. Bone marrow was normocellular and reactive, with histiocytic hemophagocytosis and atypical, non-caseous necrotic regions (hematoxylin and eosin stain, ×400).

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  Fig. 2. Metaphor agarose gel (4%) electrophoresis of the Msp I-digested PCR product. Lane M, molecular size marker. Lane 1, bone marrow specimen of the patient, showing a protein profile similar to that of Mycobacterium avium (105 bp, 80 bp, 50 bp, and 45 bp). Lane 2, positive control (Mycobacterium tuberculosis; 175 bp, 80 bp, 60 bp, and 40 bp). Lane 3, negative control.

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  Fig. 3. Phylogenetic tree constructed using the rpoB gene sequences. Samples 1 and 2 are bone marrow specimens from the patient.

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