Mesenteritis in immunosuppressed patient with Mycobacterium genavense infection

Caeiro, Alexandra; Garrote, Ana Raquel; Cabo, J. F. González; Cardoso, O.; Martins, Teresa; Maltêz, Fernando

doi:10.1097/qad.0000000000002375

Cited by 3 publications

(8 citation statements)

References 11 publications

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“…[19] However, this combination treatment was used in 1 patient with secondary sclerosing mesenteritis due to M. genavense infection with poor results. [8] To the best of our knowledge, this is the first reported case of M. genavense infection successfully treated by surgery. Intestinal M. tuberculosis infections complicated with perforation or obstruction have already been surgically treated, essentially in an emergency situation, but surgical management of mesenteric lymphadenitis and caseum has rarely been described.…”

Section: Discussionmentioning

confidence: 77%

“…[19] However, this combination treatment was used in 1 patient with secondary sclerosing mesenteritis due to M. genavense infection with poor results. [8]…”

Section: Discussionmentioning

confidence: 99%

“…[6,7] It is characterized by a diffuse, localized or multinodular thickening of the mesentery, with chronic inflammation and fibrosis, causing thrombotic events and great morbidity. [6,8] As it is a rare condition, experience about its optimal management is scarce. Here we present a case of persisting M. genavense infection in an HIV-infected patient who developed sclerosing mesenteritis and in whom a combination of medical and surgical treatment was proposed.…”

Section: Introductionmentioning

confidence: 99%

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Sclerosing mesenteritis due to Mycobacterium genavense infection: A case report

et al. 2022

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Rationale: Since its first identification in the early 1990s, Mycobacterium genavense has been considered and opportunistic pathogen. It mainly causes gastrointestinal symptoms, but also disseminated infections in severely immunosuppressed patients. Sclerosing mesenteritis is a long-term complication with high morbidity and mortality. As it is a rare condition, there are no specific guidelines for its management. We report a challenging case of persistent M. genavense infection, and propose surgery as an alternative treatment strategy.Patient concerns: A 38-year-old Caucasian man presented to the emergency room with fever, abdominal pain, and night sweats for 3 months. HIV screening revealed a previously unknown HIV-1 infection, with a CD4 cell count of 216 cell/µL and viral load of 361.000 copies/mL at diagnosis. A body CT-scan showed mild splenomegaly as well as mesenteric and retroperitoneal enlarged lymph nodes. Fine needle aspiration revealed the presence of acid-fast bacilli, but mycobacterial cultures were negative. In the second sample, 16S RNA sequencing yielded a diagnosis of M. genavense infection. Despite 2 years of corticosteroids and antimycobacterial treatment excluding rifampicin due to a severe cutaneous reaction, there was no clinical improvement and an increase in the mesenteric lymph node size was observed, with a sclerosing transformation of the mesentery. A surgical approach was proposed to release small bowel loops and to remove fibrin. A second surgery was required due to an acute peritonitis ought to yeyunal segmental isquemia and perforation. Finally, the patient evolved favorably, and antimycobacterial drugs were suspended without relapse.Lessons.Despite a prolonged multidrug strategy, some patients develop persistent M. genavense infection. Once sclerosing mesenteritis is established, clinicians have few treatment options. Surgery should be considered in patients with sclerosing mesenteritis or bowel obstruction. The combination of medical and surgical treatment could be a potential cure for these patients.Abbreviations: AIDS = acquired immunodeficiency syndrome, ART = antiretroviral therapy, FDG = fluorodeoxyglucose, HIV = human immunodeficiency virus, IGRA = interferon-gamma release assay, MAC = Mycobacterium avium complex, PCR = polymerase chain reaction, PET/CT = positron emission tomography/computed tomography.

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Section: Discussionmentioning

confidence: 77%

“…[19] However, this combination treatment was used in 1 patient with secondary sclerosing mesenteritis due to M. genavense infection with poor results. [8]…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sclerosing mesenteritis due to Mycobacterium genavense infection: A case report

et al. 2022

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“…

Mycobacterium genavense mesenteritis responsible for refractory chylous ascites despite multiple immunomodulatory therapies in a patient with AIDS Mycobacterium genavense has a well-known high affinity for the gastrointestinal tract and mesentery, where it may cause pathogen-specific syndromes, including retractile-mesenteritis mass, duodenal thickening, ascites and thrombotic occlusions of the abdominal vessels [1,2].M. genavense mesenteritis mostly becomes manifest during immune reconstitution inflammatory syndrome (IRIS) [1,[3][4][5]. We describe the failure of various immunomodulatory therapies over 7 years of follow-up, for steroiddependent M. genavense mesenteritis IRIS responsible for refractory chylous ascites in a patient with AIDS.In December 2015, a 32-year-old HIV-1-infected woman was diagnosed with disseminated infection by M. genavense.

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mentioning

confidence: 99%

“…M. genavense mesenteritis mostly becomes manifest during immune reconstitution inflammatory syndrome (IRIS) [1,3–5]. We describe the failure of various immunomodulatory therapies over 7 years of follow-up, for steroid-dependent M. genavense mesenteritis IRIS responsible for refractory chylous ascites in a patient with AIDS.…”

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confidence: 99%