Non-Tuberculous Mycobacterial Infection Localized in Small Intestine Developing after Allogeneic Bone Marrow Transplantation

Yamazaki, Rie; Mori, Takehiko; Nakazato, Tomonori; Aisa, Yoshinobu; Imaeda, Hiroyuki; Hisamatsu, Tadakazu; Hibi, Toshifumi; Okamoto, Shinichiro

doi:10.2169/internalmedicine.49.3288

Cited by 43 publications

(6 citation statements)

References 11 publications

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“…A paediatric HSCT recipient was reported to have developed pyrexia and watery diarrhoea, with nontuberculous mycobacteria (subtyped as Mycobacterium avium) demonstrated in macrophages in duodenal and colonic biopsies, 51 whereas an adult HSCT patient with similar symptoms showed non-tuberculous mycobacteria (subtype not given) in macrophages arranged as infiltrating sheets in small intestinal biopsies. 52 By contrast, an adult heart transplant recipient developed M. avium infection of intra-abdominal lymph nodes and the proximal small bowel, and his duodenal biopsies were reported to show non-caseating granulomas containing acid-fast bacilli. 53 Further, a liver transplant recipient developed an 'oedematous jejunal lesion' containing non-caseating granulomas with mycobacteria, and M. gordonae were demonstrated in a gastric aspirate.…”

Section: N O N -T U B E R C U L O U S M Y C O B a C T E R I Amentioning

confidence: 99%

“…Gastrointestinal involvement has only rarely been described, and there are even fewer descriptions of the histological manifestations of such involvement. A paediatric HSCT recipient was reported to have developed pyrexia and watery diarrhoea, with non‐tuberculous mycobacteria (subtyped as Mycobacterium avium ) demonstrated in macrophages in duodenal and colonic biopsies, whereas an adult HSCT patient with similar symptoms showed non‐tuberculous mycobacteria (subtype not given) in macrophages arranged as infiltrating sheets in small intestinal biopsies . By contrast, an adult heart transplant recipient developed M. avium infection of intra‐abdominal lymph nodes and the proximal small bowel, and his duodenal biopsies were reported to show non‐caseating granulomas containing acid‐fast bacilli .…”

Section: Infectionsmentioning

confidence: 99%

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Gastrointestinal pathology in transplant patients

Wong

2014

Histopathology

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The assessment of gastrointestinal (GI) specimens from transplant patients is complicated by the wide range of potentially rare pathologies that may be found in this clinical setting. Acute GI graft-versus-host disease (GvHD) is characterized by epithelial cell apoptosis, although there is increasing recognition that acute and/or chronic inflammation may also be present. By contrast, thus far there are no histological features known to be specific to chronic GI GvHD. Mycophenolate mofetil colitis may mimic both GvHD and inflammatory bowel disease, whereas both cytomegalovirus (CMV) and adenovirus infections can cause gland apoptosis. Post-transplant lymphoproliferative disorder should be considered if a Crohn's-like histological picture is seen, and granulomas in biopsies from umbilical cord blood recipients should raise a suspicion of cord colitis syndrome. Finally, the GI tract may be involved directly or indirectly by the disease that originally required haematopoietic stem cell or liver transplantation.

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Section: N O N -T U B E R C U L O U S M Y C O B a C T E R I Amentioning

confidence: 99%

Section: Infectionsmentioning

confidence: 99%

Gastrointestinal pathology in transplant patients

Wong

2014

Histopathology

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“…Mori et al reported that the use of systemic corticosteroids after allogeneic HSCT delays immune reconstitution [19,20]; therefore, the immunosuppressive state might have contributed to the atypical clinical and radiological appearance and progression in this patient. In addition, this patient showed only pulmonary manifestations of NTM, but Yamazaki et al reported a case of NTM infection localized only in the small intestine after allogeneic BMT [20], and physicians should take into account the possibility of localized pulmonary or intestinal MAC infections in patients in an immunosuppressed state after BMT. However, an evaluation of the upper and lower intestinal tracts was not performed in the present study.…”

Section: Discussionmentioning

confidence: 88%

A Case of Rapid Exacerbation of Pulmonary <i>Mycobacterium Avium</i> Complex Infection Mimicking Pulmonary Aspergillosis

Noguchi

Yatera

Yamasaki

et al. 2015

J UOEH

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We herein report a case of pulmonary Mycobacterium avium complex (MAC) infection with pulmonary multiple nodules and the "halo sign" on chest computed tomography (CT) in which the patient showed rapid exacerbation seven years after undergoing bone marrow transplantation (BMT). A 68-year-old Japanese female visited our hospital due to a productive cough and dyspnea. She had undergone allogeneic BMT for acute myelocytic leukemia and received both prednisolone (2 mg/day) and cyclosporine (30 mg/day). Chest CT demonstrated no abnormal findings on admission; however, multiple pulmonary nodules and the "halo sign" were detected three weeks later. Although a fungal infection was initially suspected, a bronchoscopic examination revealed pulmonary MAC infection. In the present case, pulmonary MAC infection exhibited rapid progression with unique CT findings. Physicians should consider MAC infection in the differential diagnosis in patients who receive BMT and/or immunosuppressive agents, even if the clinical and radiological findings are atypical of the disease.

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“…Cough, sputum, hemosputum, and weight loss are common symptoms of NTM infection (5,12,13), although abdominal symptoms, such as diarrhea, are uncommon. In addition, intestinal NTM infection is generally quite rare, although Huh et al reported that M. avium-intracellulare complex (MAC) was one of the common causes of intestinal infection in patients with acquired immunodeficiency syndrome, and that intestinal MAC infection may lead to diarrhea (14,15). The side effects of macrolide, a key drug for the treatment of NTM infection, also include abdominal symptoms, such as diarrhea.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary <i>Mycobacterium abscessus</i> Infection with Reactive AA Amyloidosis: A Case Report and Brief Review of the Literature

et al. 2019

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We herein report a case involving a 64-year-old Japanese woman with a pulmonary Mycobacterium abscessus infection complicated by reactive AA amyloidosis, which, to our knowledge, has not been reported to date. The patient underwent gastrointestinal endoscopy for diarrhea during the treatment of pulmonary M. abscessus infection and was diagnosed with AA amyloidosis according to the histopathological findings from the endoscopic specimen. She died four months later. The prognosis of AA amyloidosis associated with pulmonary M. abscessus infection may be very poor, and physicians should pay attention to this rare condition when difficult-to-treat diarrhea occurs in patients with pulmonary M. abscessus infection.

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Non-Tuberculous Mycobacterial Infection Localized in Small Intestine Developing after Allogeneic Bone Marrow Transplantation

Abstract: A 33-year-old

Cited by 43 publications

References 11 publications

Gastrointestinal pathology in transplant patients

Gastrointestinal pathology in transplant patients

A Case of Rapid Exacerbation of Pulmonary <i>Mycobacterium Avium</i> Complex Infection Mimicking Pulmonary Aspergillosis

Pulmonary <i>Mycobacterium abscessus</i> Infection with Reactive AA Amyloidosis: A Case Report and Brief Review of the Literature

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