PDF
ePub
Citation
Print
Abstract
Isolated bone marrow infection by nontuberculous mycobacteria (NTM) is extremely rare. Recently, we encountered a case of bone marrow Mycobacterium avium complex (MAC) infection, which presented as a fever of unknown origin shortly after starting continuous ambulatory peritoneal dialysis (CAPD). The patient was diagnosed with MAC infection on the basis of PCR-restriction fragment length polymorphism analysis and sequencing of DNA obtained from bone marrow specimens. Although this was a case of severe MAC infection, there was no evidence of infection of other organs. End-stage renal disease (ESRD) patients undergoing dialysis can be considered immunodeficient; therefore, when these patients present with fever of unknown origin, opportunistic infections such as NTM infection should be considered in the differential diagnosis.
REFERENCES
1.Pulliam JP., Vernon DD., Alexander SR., Hartstein AI., Golper TA. Nontuberculous mycobacterial peritonitis associated with continuous ambulatory peritoneal dialysis. Am J Kidney Dis. 1983. 2:610–4.
2.Perazella M., Eisen T., Brown E. Peritonitis associated with disseminated Mycobacterium avium complex in an acquired immunodeficiency syndrome patient on chronic ambulatory peritoneal dialysis. Am J Kidney Dis. 1993. 21:319–21.
3.Perlino CA. Mycobacterium avium complex: an unusual cause of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. Clin Infect Dis. 1993. 17:1083–4.
4.Irizarry L., Rupp J., Smart J., Nwosu A., Tzamaloukas A. Diagnostic difficulties with mycobacteria peritonitis in a CAPD patient. Perit Dial Int. 1996. 16:427.
5.Ferrara E., Lemire J., Grimm PC., Reznik VM., Mendoza SA., Leake JA, et al. Mycobacterial peritonitis in pediatric peritoneal dialysis patients. Pediatr Nephrol. 2004. 19:114–7.
6.Griffith DE., Aksamit T., Brown-Elliott BA., Catanzaro A., Daley C., Gordin F, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007. 175:367–416.
7.Otaki Y., Nakanishi T., Nanami M., Aizawa M., Yanase K., Hiraoka K, et al. A rare combination of sites of involvement by Mycobacterium intracellulare in a hemodialysis patient: multifocal synovitis, spondylitis, and multiple skin lesions. Nephron. 2002. 92:730–4.
8.Wen YK., Chen ML. Crescentic glomerulonephritis associated with non-tuberculous mycobacteria infection. Ren Fail. 2008. 30:339–41.
9.Cuervo LM., Martinez FR., Guillot FB., Martinez JC., Font ME. Report of Mycobacterium avium-intracellulare associated with kidney mycobacteriosis. Rev Cubana Med Trop. 2003. 55:58–60.
10.O'Brien RJ., Geiter LJ., Snider DE Jr. The epidemiology of nontuberculous mycobacterial diseases in the United States. Results from a national survey. Am Rev Respir Dis. 1987. 135:1007–14.
11.Chaisson RE., Moore RD., Richman DD., Keruly J., Creagh T. Incidence and natural history of Mycobacterium avium-complex infections in patients with advanced human immunodeficiency virus disease treated with zidovudine. The Zidovudine Epidemiology Study Group. Am Rev Respir Dis. 1992. 146:285–9.
Fig. 1.
Bone marrow was normocellular and reactive, with histiocytic hemophagocytosis and atypical, non-caseous necrotic regions (hematoxylin and eosin stain, ×400).
Fig. 2.
Metaphor agarose gel (4%) electrophoresis of the Msp I-digested PCR product. Lane M, molecular size marker. Lane 1, bone marrow specimen of the patient, showing a protein profile similar to that of Mycobacterium avium (105 bp, 80 bp, 50 bp, and 45 bp). Lane 2, positive control (Mycobacterium tuberculosis; 175 bp, 80 bp, 60 bp, and 40 bp). Lane 3, negative control.
XML Download