Disseminated Mycobacterium avium-intracellulare infection in a patient with myelodysplastic syndrome (refractory anemia).
A 31-year-old woman presented with fever and arthralgia. Despite treatment with antimicrobials and corticosteroids, her symptoms persisted. A diagnosis of myelodysplastic syndrome (MDS)-refractory anemia (RA) was made by pancytopenia, dysplasia, and trisomy 8. Cultures of bone marrow, blood, and gastric juice showed Mycobacterium avium-intracellulare (MAI). She was treated with antimycobacterial drugs and recombinant human G-CSF/M-CSF and showed an initial response, but spike fever recurred and pancytopenia progressed. Hepatosplenomegaly and marked retroperitoneal lymphadenopathy were revealed, indicating further dissemination of MAI. Treatment with recombinant human GM-CSF and very-low-dose cytosine arabinoside, was started but was not effective. This case showed significant reduction in peripheral blood T-lymphocytes, especially the CD4+ population, and low immunoglobulin levels. Immunodeficiency state associated with long-term steroid therapy and MDS seemed to contribute to the development of the disseminated infection with MAI.
Tsukada
H
H
Department of Medicine (II), Niigata University Medical School, Japan.
Chou
T
T
Ishizuka
Y
Y
Ogawa
O
O
Saeki
T
T
Ito
S
S
Wakabayashi
M
M
Hayashi
N
N
Arakawa
M
M
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology; D000328:Adult; D000753:Anemia, Refractory / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D001853:Bone Marrow / Q000382:microbiology; D015704:CD4 Antigens / Q000032:analysis; D003561:Cytarabine / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D005750:Gastric Juice / Q000382:microbiology; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000097:blood / Q000627:therapeutic use; D006801:Humans; D016173:Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D011994:Recombinant Proteins / Q000627:therapeutic use; D013601:T-Lymphocytes / Q000276:immunology / Q000473:pathology; D013997:Time Factors
D015704:CD4 Antigens; D011994:Recombinant Proteins; D003561:Cytarabine; D016173:Macrophage Colony-Stimulating Factor; D016178:Granulocyte-Macrophage Colony-Stimulating Factor