Mycobacterium genavense mesenteritis responsible for refractory chylous ascites despite multiple immunomodulatory therapies in a patient with AIDS

Abstract

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. She had been diagnosed with HIV in 2002 and was on

Successful rescue TNF-α blocking for Mycobacterium genavense – Related immune reconstitution inflammatory syndrome: A case report

“…Indeed, the delay between the first symptoms of IRIS and the first treatment of IRIS is, on average, nine months, and between the first symptoms of IRIS and infliximab is, on average, 22 months in the case of our patients. Thus, unlike IRIS described by Manion and Baldolli [ 21 , 22 ] happened within weeks of infection diagnosis, the late-onset of IRIS presented by our patients and by the case of Laurent et al (17 months) has until now never been reported in scientific literature and should encourage clinicians to discuss this diagnosis in all patients with clinical worsening irrespective of the delay related to M. genavense initial diagnosis [ 23 ]. Therefore, late-onset IRIS has also been described in other opportunistic infections among HIV patients.…”

“…Two case reports have been published concerning successful treatment with infliximab in steroid-dependent IRIS due to disseminated M. genavense disease, with a favorable clinical and radiological outcome for both patients [ 21 , 22 ]. To qualify, a case recently reported by Laurent et al described a late-onset (after seven years) fatal multi-refractory IRIS related to M. genavense in an HIV patient with ascites and portal thrombosis despite an increased dose of infliximab (10 mg/kg/month) and concomitant treatment with corticosteroids and colchicine [ 23 ]. Except for M. genavense and tuberculosis, only three cases of steroid-dependent IRIS in relation with a M. avium complex infection successfully treated with anti-TNF-alpha were reported, among which two received three injections and one was treated with 13 injections of infliximab [ 15 , 24 ].…”