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Disseminated Mycobacterium intracellulare Infection in an Immunocompetent Host.

Kim WY, Jang SJ, Ok T, Kim GU, Park HS, Leem J, Kang BH, Park SJ, Oh DK, Kang BJ, Lee BY, Ji WJ, Shim TS - Tuberc Respir Dis (Seoul) (2012)

Bottom Line: Disseminated Mycobacterium avium complex (MAC) infection can occur in immunocompromised patients, and rarely in immunocompetent subjects.We report a case of disseminated Mycobacterium intracellulare disease in an immunocompetent patient, which involved the lung, lymph nodes, spleen, and multiple bones.F-18 fluorodeoxyglucose positron-emission tomography imaging showed multiple hypermetabolic lesions, which are suggestive of typical hematogenous metastasis.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
Disseminated Mycobacterium avium complex (MAC) infection can occur in immunocompromised patients, and rarely in immunocompetent subjects. Due to the extensive distribution of the disease, clinical presentation of disseminated MAC may mimic malignancies, and thorough examinations are required in order to make accurate diagnosis. We report a case of disseminated Mycobacterium intracellulare disease in an immunocompetent patient, which involved the lung, lymph nodes, spleen, and multiple bones. F-18 fluorodeoxyglucose positron-emission tomography imaging showed multiple hypermetabolic lesions, which are suggestive of typical hematogenous metastasis. However, there was no evidence of malignancy in serial biopsies, and M. intracellulare was repeatedly cultured from respiratory specimens and bones. Herein, we should know that disseminated infection can occur in the immunocompetent subjects, and it can mimic malignancies.

No MeSH data available.


Related in: MedlinePlus

Contrast enhanced computed tomography showed consolidation in the lingual segment of left upper lobe (A) and bilateral meditational lymph nodes swelling (B).
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Figure 2: Contrast enhanced computed tomography showed consolidation in the lingual segment of left upper lobe (A) and bilateral meditational lymph nodes swelling (B).

Mentions: Findings of laboratory studies showed a white-blood-cell count of 18,000/mm3 with 76.6% neutrophils, hemoglobin 10.8 g/dL, and platelet count 462,000/mm3. Electrolytes, measures of renal function, and liver enzymes were within normal limits. C-reactive protein (CRP) was elevated to 15.34 mg/dL. Serologic test for human immunodeficiency virus gave negative result. Initial blood and sputum cultures remained negative, but the patient was started on piperacillin/tazobactam (18 g per day) and ciprofloxacin (800 mg per day) as an empirical antibacterial therapy. Chest X-ray showed the ill-defined patchy mass opacity with surrounding ground-glass opacity in left mid-lung field (Figure 1). Chest CT showed huge mass-like consolidation in the lingular segment of left upper lobe and enlarged bilateral supraclavicular and mediastinal lymph nodes, suggestive of malignancy or inflammatory disease (Figure 2).


Disseminated Mycobacterium intracellulare Infection in an Immunocompetent Host.

Kim WY, Jang SJ, Ok T, Kim GU, Park HS, Leem J, Kang BH, Park SJ, Oh DK, Kang BJ, Lee BY, Ji WJ, Shim TS - Tuberc Respir Dis (Seoul) (2012)

Contrast enhanced computed tomography showed consolidation in the lingual segment of left upper lobe (A) and bilateral meditational lymph nodes swelling (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3475463&req=5

Figure 2: Contrast enhanced computed tomography showed consolidation in the lingual segment of left upper lobe (A) and bilateral meditational lymph nodes swelling (B).
Mentions: Findings of laboratory studies showed a white-blood-cell count of 18,000/mm3 with 76.6% neutrophils, hemoglobin 10.8 g/dL, and platelet count 462,000/mm3. Electrolytes, measures of renal function, and liver enzymes were within normal limits. C-reactive protein (CRP) was elevated to 15.34 mg/dL. Serologic test for human immunodeficiency virus gave negative result. Initial blood and sputum cultures remained negative, but the patient was started on piperacillin/tazobactam (18 g per day) and ciprofloxacin (800 mg per day) as an empirical antibacterial therapy. Chest X-ray showed the ill-defined patchy mass opacity with surrounding ground-glass opacity in left mid-lung field (Figure 1). Chest CT showed huge mass-like consolidation in the lingular segment of left upper lobe and enlarged bilateral supraclavicular and mediastinal lymph nodes, suggestive of malignancy or inflammatory disease (Figure 2).

Bottom Line: Disseminated Mycobacterium avium complex (MAC) infection can occur in immunocompromised patients, and rarely in immunocompetent subjects.We report a case of disseminated Mycobacterium intracellulare disease in an immunocompetent patient, which involved the lung, lymph nodes, spleen, and multiple bones.F-18 fluorodeoxyglucose positron-emission tomography imaging showed multiple hypermetabolic lesions, which are suggestive of typical hematogenous metastasis.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
Disseminated Mycobacterium avium complex (MAC) infection can occur in immunocompromised patients, and rarely in immunocompetent subjects. Due to the extensive distribution of the disease, clinical presentation of disseminated MAC may mimic malignancies, and thorough examinations are required in order to make accurate diagnosis. We report a case of disseminated Mycobacterium intracellulare disease in an immunocompetent patient, which involved the lung, lymph nodes, spleen, and multiple bones. F-18 fluorodeoxyglucose positron-emission tomography imaging showed multiple hypermetabolic lesions, which are suggestive of typical hematogenous metastasis. However, there was no evidence of malignancy in serial biopsies, and M. intracellulare was repeatedly cultured from respiratory specimens and bones. Herein, we should know that disseminated infection can occur in the immunocompetent subjects, and it can mimic malignancies.

No MeSH data available.


Related in: MedlinePlus