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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

Maximum intensity projection image of F-18 fluorodeoxyglucose positron-emission tomography on admission showed multifocal hypermetabolic lesions in the left upper lung, lymph nodes, spleen, and multiple bones.
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Figure 4: Maximum intensity projection image of F-18 fluorodeoxyglucose positron-emission tomography on admission showed multifocal hypermetabolic lesions in the left upper lung, lymph nodes, spleen, and multiple bones.

Mentions: During five days of antibiotic treatment, neither clinical nor radiologic improvement was observed. Brochoalveolar lavage (BAL) and endobronchial ultrasoundguided transbronchial needle aspiration (EBUS-TBNA) for paratracheal and subcarinal lymph nodes were performed, and the findings were unremarkable. The patient remained febrile after seven days of initial antibiotic therapy, and the regimen was changed to meropenem (3 g per day) and vancomycin (2 g per day). In addition to respiratory symptoms, the patient complained of back pain. Magnetic resonance imaging (MRI) of the thoracic and lumbar spine was performed and showed diffuse heterogenous low signal change with heterogenous enhancement (Figure 3). From this MRI finding, marrow infiltrative diseases such as multiple myeloma, malignant lymphoma, and multiple metastasis of unknown origin were considered. There was no evidence of monoclonal gammopathy based on serum and urine electrophoresis. FDG PET was performed and maximum intensity projection image showed multifocal hypermetabolic lesion in the lingular segment of left upper lung, bilateral supraclavicular and mediastinal lymph nodes, spleen, and multiple bones, including spine, right humerus, both scapula, left clavicle, sternum, sacrum, both pelvic bones, both femurs, and both side ribs (Figure 4). At this point, we had a high suspicion of hidden malignancy and performed percutaneous needle biopsy (PCNB) in the left upper lobe consolidation and left supraclavicular lymph node. However, both pathologies revealed nonspecific chronic inflammation and interstitial fibrosis and there was no evidence of malignancy or granulomas. Then, CT-guided bone biopsy was performed in the first lumbar vertebrae, and the pathology showed myeloid hyperplasia with marked plasmacytosis, without the evidence of malignant cell infiltration.


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)

Maximum intensity projection image of F-18 fluorodeoxyglucose positron-emission tomography on admission showed multifocal hypermetabolic lesions in the left upper lung, lymph nodes, spleen, and multiple bones.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Maximum intensity projection image of F-18 fluorodeoxyglucose positron-emission tomography on admission showed multifocal hypermetabolic lesions in the left upper lung, lymph nodes, spleen, and multiple bones.
Mentions: During five days of antibiotic treatment, neither clinical nor radiologic improvement was observed. Brochoalveolar lavage (BAL) and endobronchial ultrasoundguided transbronchial needle aspiration (EBUS-TBNA) for paratracheal and subcarinal lymph nodes were performed, and the findings were unremarkable. The patient remained febrile after seven days of initial antibiotic therapy, and the regimen was changed to meropenem (3 g per day) and vancomycin (2 g per day). In addition to respiratory symptoms, the patient complained of back pain. Magnetic resonance imaging (MRI) of the thoracic and lumbar spine was performed and showed diffuse heterogenous low signal change with heterogenous enhancement (Figure 3). From this MRI finding, marrow infiltrative diseases such as multiple myeloma, malignant lymphoma, and multiple metastasis of unknown origin were considered. There was no evidence of monoclonal gammopathy based on serum and urine electrophoresis. FDG PET was performed and maximum intensity projection image showed multifocal hypermetabolic lesion in the lingular segment of left upper lung, bilateral supraclavicular and mediastinal lymph nodes, spleen, and multiple bones, including spine, right humerus, both scapula, left clavicle, sternum, sacrum, both pelvic bones, both femurs, and both side ribs (Figure 4). At this point, we had a high suspicion of hidden malignancy and performed percutaneous needle biopsy (PCNB) in the left upper lobe consolidation and left supraclavicular lymph node. However, both pathologies revealed nonspecific chronic inflammation and interstitial fibrosis and there was no evidence of malignancy or granulomas. Then, CT-guided bone biopsy was performed in the first lumbar vertebrae, and the pathology showed myeloid hyperplasia with marked plasmacytosis, without the evidence of malignant cell infiltration.

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