title: [A case of disseminated nontuberculous mycobacteriosis during purpura associated with hypergammaglobulinemia and hepatitis type C].
abstract: A 74-year-old woman with hepatitis due to hepatitis C virus followed up using oral predonisolone (3 mg/day) for two years because of hypergammaglobulinemia-associated purpura reported fever and lumbago in February 2005. Upon admission in June, she was found in chest-computed tomography to have atelectasia in the right middle lung lobe and a nodule with a cavity in the right lower lobe. She tested positive for tuberculous glycolipid antibody. Gallium scintigraphy showed an abnormal accumulation in the lower lumbar vertebra. Magnetic resonance imaging showed abnormal enhancement at L4, L5, and their intervertebral disc. Mycobacterium intracellulare (M. intracellulare) was detected in blood culture, bronchoalveolar lavage, and a biopsy specimen from the intervertebral disc, yielding a diagnosis of disseminated nontuberculous mycobacteriosis (NTM) due to M. intracellulare. She was treated with clarithromycin (CAM), ethambutol (EB), and rifampicin (RFP), but EB and RFP were discontinued due to of the fever they induced. She was then treated with a combination of CAM, levofloxacin, and streptomycin and followed up as an out patient. Based on case reports of disseminated NTM infection in Japan, the prognosis is poor and a protocol must be established for its treatment.
authors.affiliation: Department of Rheumatology, Infectious diseases and Laboratory Medicine, Faculty of Medicine, University of Miyazaki.
authors.forename: Shiro
authors.initials: S
authors.lastname: Ueno
authors.forename: Shunichi
authors.initials: S
authors.lastname: Miyauchi
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Umekita
authors.forename: Norio
authors.initials: N
authors.lastname: Kusumoto
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takajo
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kuroki
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Kai
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nagatomo
authors.forename: Akihiko
authors.initials: A
authors.lastname: Okayama
mesh_terms: D000368:Aged; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D006942:Hypergammaglobulinemia / Q000150:complications*; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications*; D011694:Purpura, Hyperglobulinemic / Q000150:complications*