title: Infection with Mycobacterium genavense in a patient with systemic lupus erythematosus.
abstract: A 55-year-old woman with systemic lupus erythematosus was admitted with fever of unknown origin. She had been on an immunosuppressive regimen for the past 8 years including steroids and Azathioprine. Laboratory parameters revealed a markedly elevated C-reactive protein of 189 mg/l, antinuclear antibodies of 1:2,560, a hemoglobin level of 9.0 g/dl, and a severe lymphopenia (total lymphocytes 49.4/microl, CD4(+) cells 2/microl, CD8(+) cells 7/microl). Neither blood culture samples nor computed tomography and magnetic resonance imaging of the chest and abdomen nor a trans-esophageal echocardiography revealed positive results. A bone marrow biopsy did not show signs of hematologic disease, but revealed a small granuloma rife with acid-fast bacilli, which were later confirmed to be Mycobacterium genavense by gene sequencing. To our knowledge, this is the first case involving M. genavense infection in a patient with systemic lupus erythematosus. In contrast to other reports regarding disseminated M. genavense infection, the patient is still alive and well.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Hanover Medical School, Carl-Neuberg-Strasse 1, 30625, Hanover, Germany. J.M.Lorenzen@gmail.com
authors.forename: Johan
authors.initials: J
authors.lastname: Lorenzen
authors.forename: Dirk
authors.initials: D
authors.lastname: Meyer-Olson
authors.forename: Marion
authors.initials: M
authors.lastname: Haubitz
authors.forename: Torsten
authors.initials: T
authors.lastname: Witte
authors.forename: Franz
authors.initials: F
authors.lastname: Bange
authors.forename: Reinhold
authors.initials: R
authors.lastname: Schmidt
authors.forename: Matthias
authors.initials: M
authors.lastname: Stoll
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000900:Anti-Bacterial Agents