Mycobacterium simiae pulmonary infection in a patient with AIDS.
Int Conf AIDS 2000 Jul 9-14; 13:40 (abstract no.. LbPeA7034)
de la Pena N, Lutwick L, Sathe S SUNY Downstate Medical Center, Brooklyn, NY 11203. Fax: +1 718-270-2465, E-mail: Ndelap1070@aol.com.
We report a case of a 44-year old African-American man from New Jersey, USA with a history of sarcoidosis, AIDS(CD4=24,Viral Load=130,000) for 4 years and not on HAART because of intolerance, who presented with a 6-month history of coughing, intermittent hemoptysis and low-grade fever, a 20-lb weight loss and drenching night sweats. On physical examination, he had a 4x2 anterior neck ulcer, perianal ulcers and a normal pulmonary examination. His arterial blood gas revealed hypoxia with a widened A-a gradient. A CAT scan of his chest revealed perihilar cavitation and paratracheal adenopathy with diffuse infiltrates. He was empirically treated for PCP. Sputum and blood were negative for AFB. He was also found to have cryptococcal fungemia without meningitis. His neck and perianal ulcers were positive for Herpes simplex I and Herpes simplex 2, respectively. He was treated with amphotericin B and IV acyclovir. Though he subjectively improved, fever, cough and dyspnea were persistent. A bronchoscopy revealed foamy exudates suggestive of PCP with no evidence of cryptococcal infection. Five AFB smear-negative sputa and one AFB-smear positive BAL washing grew creamy colonies on solid media after 4 weeks which were macin-positive and was subsequently identified as Mycobacterium simiae by high-performance liquid chromatography. The isolates were sensitive to rifabutin, ethionamide and cycloserine. He was treated with these medications and his symptoms completely resolved. Using American Thoracic Society guidelines, this patient's symptomatology, CAT scan results and persistent isolation of Mycobacterium simiae from the sputum and bronchial washing and his response to treatment suggest a true infection and not colonization. It is undetermined as to how he acquired the infection since he had no history of travel outside New Jersey or New York, no contact with animals and no similar mycobacteria isolated from the hospital tap water.
Keywords: AEGIS, Acquired Immunodeficiency Syndrome, Mycobacteria, Atypical, Respiratory Tract Infections, Mycobacterium Infections, Atypical, Sputum, Mycobacterium avium-intracellulare Infection, Mycobacterium, Mycobacterium Infections, Antiretroviral Therapy, Highly Active, Hemoptysis, Bronchoscopy, Herpes Simplex, Ulcer, New Jersey, New York, Human, Male, Cats, Animal, AIDS
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LbPeA7034
