Infect Chemother.  2008 Oct;40(5):297-300. 10.3947/ic.2008.40.5.297.

Disseminated Mycobacterium avium Complex Infection in a Patient with Acquired Immunodeficiency Syndrome

• Yi SH
• Choi JH
• Choi MH
• Shin DW
• Choi JH
• Kim TY
• Jeon MH
• Koh ES
• Choo EJ

• KMID: 2285057
• DOI: http://doi.org/10.3947/ic.2008.40.5.297

Abstract

Nontuberculous Mycobacteria, especially Mycobacterium avium complex (MAC) infection is a common opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS). In patients with AIDS, MAC infection more frequently presents as disseminated form rather than localized infection. Disseminated MAC infection is associated with a high mortality rate in patient with AIDS. We report a case of disseminated MAC infection in an AIDS patient involving bone marrow, mediastinal lymph node and lung.

Keyword

Mycobacterium avium complex; AIDS

MeSH Terms

Acquired Immunodeficiency Syndrome
Bone Marrow
Humans
Lung
Lymph Nodes
Mycobacterium
Mycobacterium avium
Mycobacterium avium Complex
Nontuberculous Mycobacteria
Opportunistic Infections

Figure

• 

  Figure 1 Brownish colored macules or patches with scales in right lower arm. The skin lesions were on the entire body accompanied by pruritus. The largest lesion was 1.5 by 1 cm sized.

• 

  Figure 2A Enhanced chest CT shows multiple mediastinal lymphadenopathy.

• 

  Figure 2B PET CT shows increased uptake in multiple mediastinal lymph nodes.

• 

  Figure 3A Mediastinal lymph node biopsy shows chronic granulomatous inflammation (×100).

• 

  Figure 3B Numerous acid-fast bacteria were noted on Ziehl-Neelsen stain in mediastinal lymph node biopsy (×1,000).

Reference

1. Benator DA, Gordin FM. Nontuberculous mycobacteria in patients with human immunodeficiency virus infection. Semin Respir Infect. 1996. 11:285–300.

2. Rossi M, Flepp M, Telenti A, Schiffer V, Egloff N, Bucher H, Vernazza P, Bernasconi E, Weber R, Rickenbach M, Furrer H. Swiss HIV Cohort Study. Swiss HIV cohot study. Disseminated Mycobacterium avium complex infection in the Swiss HIV cohort study: declining incidence, improved prognosis and discontinuation of maintenance therapy. Swiss Med Wkly. 2001. 131:471–477.

3. Horsburgh CR Jr, Gettings J, Alexander LN, Lennox JL. Disseminated Mycobacterium avium complex disease among patients infected with human immunodeficiency virus, 1985-2000. Clin Infect Dis. 2001. 33:1938–1943.

4. Liao CH, Chen MY, Hsieh SM, Sheng WH, Hung CC, Chang SC. Discontinuation of secondary prophylaxis in AIDS patients with disseminated non- tuberculous mycobacteria infection. J Microbiol Immunol Infect. 2004. 37:50–56.

5. Benson CA, Kaplan JE, Masur H, Pau A, Holmes KK; CDC; National Institutes of Health; Infectious Diseases Society of America. TTreating opportunistic infections among HIV infected adults and adolescents recommendations from CDC the National Institutes of Health and the HIV Medicine Association/Infectious Diseases Society of America. MMWR Recomm Rep. 2004. 53(RR15):1–112.

6. Lee KD, Park WB, Jung HS, Kang CI, Kim DM, Kim HB, Oh MD, Choe KW. Mycobacterium avium-intracellularae meningoencephalitis in a patient with acquired immunodeficiency syndrome. Infect Chemother. 2003. 35:306–309.

7. Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO). 2007 AIDS epidemic update. 2007.

8. Koh WJ, Kwon OJ. Diagnosis and treatment of nontuberculous mycobacterial lung disease. Korean J Med. 2008. 74:120–131.

9. Nightingale SD, Byrd LT, Southern PM, Jockusch JD, Cal SX, Wynne BA. Incidence of Mycobacterium avium-intracellulare complex bacteremia in human immunodeficiency virus-positive patients. J Infect Dis. 1992. 165:1082–1085.

10. Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, Holland SM, Horsburgh R, Huitt G, Iademarco MF, Iseman M, Olivier K, Ruoss S, von Reyn CF, Wallace RJ Jr, Winthrop K. ATS Mycobacterial Diseases Subcommittee. American Thoracic Society. Infectious Disease Society of America. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007. 175:367–416.

11. Shin S, Kim EC, Yoon JH. Identification of nontuberculous mycobacteria by sequence analysis of the 16S ribosomal RNA, the heat-shock protein 65 and the RNA polymerase beta-subunit genes. Korean J Lab Med. 2006. 26:153–160.

12. Harmsen D, Rothgnger J, Frosch M, Albert J. RIDOM: Ribosomal Differentiation of Medical Micro-organisms Database. Nucleic Acids Res. 2002. 30:416–417.