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Case Reports
. 2016;55(22):3375-3381.
doi: 10.2169/internalmedicine.55.6996. Epub 2016 Nov 15.

Mycobacterium shigaense Causes Lymph Node and Cutaneous Lesions as Immune Reconstitution Syndrome in an AIDS Patient: The Third Case Report of a Novel Strain Non-tuberculous Mycobacterium

Yusuke Koizumi  1 , Kaoru Shimizu, Masayo Shigeta, Hitoshi Minamiguchi, Keiko Hodohara, Akira Andoh, Toshihide Tanaka, Kinuyo Chikamatsu, Satoshi Mitarai, Hiroshige Mikamo
Affiliations
Case Reports

Mycobacterium shigaense Causes Lymph Node and Cutaneous Lesions as Immune Reconstitution Syndrome in an AIDS Patient: The Third Case Report of a Novel Strain Non-tuberculous Mycobacterium

Yusuke Koizumi et al. Intern Med. 2016.

Abstract

A 40-year-old man complaining of progressive body weight loss was diagnosed to have acquired immunodeficiency syndrome. Within 2 weeks after the initiation of combination antiretroviral therapy, he developed fever, massive cervical lymphadenopathy and a protruding subcutaneous abscess. A lymph node biopsy and abscess drainage revealed non-caseous granuloma and mycobacterium. The mycobacterium belonged to Runyon II group, but it showed no matches to any previously reported species. According to sequence analyses, the strain was identified as Mycobacterium shigaense. After six months of antimycobacterial treatment, the lesions were all successfully cured. This is the third case report of the novel mycobacterium, M. shigaense, presenting in associatioin with immune reconstitution syndrome.

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Figures

Figure 1.
Figure 1.
Neck CT findings at day 28 of cART. a: Osteolytic invasion into the thyroid cartilage can be seen. b, c: Multiple cervical lymphadenopathy contains abscess lesions. d: Subcutaneous abscess can be seen in front of the manubrium sterni.
Figure 2.
Figure 2.
Histological findings after a lymph node biopsy. a: Granuloma is seen (Hematoxylin and Eosin staining, 40×). b: Thin acid fast bacilli are detected (Ziehl-Neelsen stain, 1,000×).
Figure 3.
Figure 3.
Scotochromogenic colonies of the Mycobacterium shigaense sub-cultured on 2% Ogawa egg slant medium.
Figure 4.
Figure 4.
Cutaneous lesions at day 31 of cART.
Figure 5.
Figure 5.
Clinical course. ABC: abacavir, ALP: alkaline phosphatase, CAM: clarithromycin, CRP: C-reactive protein, DRV/r: darunavir/ritonavir, EB: ethanbutol, INH: isoniazid, 3TC: lamivudine, RBT: rifabutin
See this image and copyright information in PMC

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