MENINGITIS AND SPLENIC INFARCTION DUE TO DISSEMINATEDMYCOBACTERIUM GENAVENSEINFECTION IN AN HIV PATIENT CASE REPORT AND REVIEW OF THE LITERATURE

Abstract

We report a case of disseminated infection with Mycobacterium genavense in a 58 year old HIV positive woman presenting with fever, diarrhea, abdominal pain and weight loss. She had a striking hepatosplenomegaly, abdominal lymphadenopathy, anaemia and thrombopenia. Direct smears and cultures of blood, stool, sputum, urine and bone marrow were negative for common and opportunistic microorganisms. Splenectomy revealed numerous acid fast bacill. Lumbar puncture also showed acid fast bacilli at direct examination. Specific PCR and 16s rRNA gene sequencing identified M. genavense. The outcome was fatal despite antimycobacterial therapy. M. genavense must be included in the differential diagnosis of fever, weight loss, lymphadenopathy and splenomegaly in immunocompromised patients. Prompt diagnosis is based on molecular biology methods. Empirical therapy, using at least three antimycobacterial agents, including clarithromycin should be introduced in case of high clinical suspicion.

Splenic infarction due to Mycobacterium avium complex infection in an HIV-infected patient with immune reconstitution failure: a case report

“…5 , 6 Because no coagulation abnormalities were found in this case, infection was initially considered. Three cases of HIV infection have been reported as the infectious cause of splenic infarction, with two cases with Mycobacterium genavense infection 7 , 8 and one case with aspergillosis infection. 9 MAC infection as an etiology of splenic infarction has not been previously reported.…”

“…Mycobacterial cultures are not performed in most comprehensive hospitals in China, and a reliable method of molecular biological identification of NTMs remains a diagnostic challenge. Apart from conventional and time-consuming mycobacterial culture, polymerase chain reaction and 16s rRNA gene sequencing 7 , 8 or reverse hybridization DNA probes are used to identify the specific organisms of NTMs. As a culture-independent method, mNGS provides a rapid etiological diagnosis, especially in critically ill patients.…”

“…The mode of transmission of MAC is thought to be through the respiratory or gastrointestinal tract. There has been a low incidence of colonization and disseminated MAC infection in the effective ART era 14 compared with the pre-ART era, 8 but the recommendation of routine primary prophylaxis for MAC is inconsistent among studies. 15 , 16 However, primary prophylaxis with clarithromycin or azithromycin should be strongly recommended in patients who do not respond to ART.…”

“…1,2 Splenic infarction is extremely rare in human immunodeficiency virus (HIV)-infected populations. [3][4][5][6][7][8][9] To date, no MAC infection has been reported to cause splenic infarction in HIV-infected patients. We report a case of splenic infarction involving MAC infection in a patient with acquired immune deficiency syndrome (AIDS) and immune reconstitution failure.…”

An unusual case of abdominal mycobacterial infection: Case report and literature review

“…Less common presentations include pleuropulmonary, cutaneous, central nervous system and genital tract involvement. 9,29 Pulmonary involvement may include cavitations and reticular–nodular infiltrates on chest X-ray. A few cases of pulmonary M. genavense disease have been documented.…”