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DOI: 10.1055/a-2388-7169
Intestinal Mycobacterium avium complex infection: a rare case of small-bowel atrophy
Authors
We report the case of a 57-year-old woman with acquired immunodeficiency syndrome (AIDS) who was admitted to the emergency room with fever, diarrhea, and severe malnutrition (body mass index [BMI] 15.8 kg/m2). Her history was notable for human immunodeficiency virus (HIV) infection with poor therapeutic adherence, which had been complicated by multiple opportunistic infections. Esophagogastroduodenoscopy and colonoscopy were macroscopically normal. A video capsule endoscopy was performed, which revealed diffuse jejunal atrophy, and whitish and edematous enteric mucosa with scalloping ([Video 1]). Subsequently, anterograde double-balloon enteroscopy confirmed significant signs of atrophy with scalloping and a mosaic pattern in the jejunum ([Fig. 1]). Subsequent histologic examination raised the suspicion of Mycobacterium avium complex (MAC) ([Fig. 2]), which was confirmed afterward by polymerase chain reaction (PCR). Treatment was therefore initiated with rifabutin, azithromycin, and ethambutol with clinical improvement.
Disseminated MAC is an infection caused by a nontuberculous mycobacterial species [1], with this type usually associated with HIV infection; however, the widespread use of effective antiretroviral therapy and the use of prophylaxis against MAC infection have reduced the incidence of this illness [2]. This case describes a rare manifestation of an infrequent opportunistic infection that is typical of AIDS patients. In addition, we report detailed imaging and video documentation of a MAC-driven enteropathy to support endoscopists and clinicians in their everyday practice.
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Conflict of Interest
The authors declare that they have no conflict of interest.
Acknowledgement
This study was partially funded by the Italian Ministry of Health, Current Research IRCCS.
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References
- 1 Grinsztejn B, Fandinho FC, Veloso VG. et al. Mycobacteremia in patients with the acquired immunodeficiency syndrome. Arch Intern Med 1997; 157: 2359
- 2 Palella Jr FJ, Delaney KM, Moorman AC. et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. NEJM 1998; 338: 853
Correspondence
Publication History
Article published online:
04 September 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Grinsztejn B, Fandinho FC, Veloso VG. et al. Mycobacteremia in patients with the acquired immunodeficiency syndrome. Arch Intern Med 1997; 157: 2359
- 2 Palella Jr FJ, Delaney KM, Moorman AC. et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. NEJM 1998; 338: 853