Infection with Mycobacterium genavense in a patient with systemic lupus erythematosus.
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.
Lorenzen
Johan
J
Department of Internal Medicine, Division of Nephrology, Hanover Medical School, Carl-Neuberg-Strasse 1, 30625, Hanover, Germany. J.M.Lorenzen@gmail.com
Meyer-Olson
Dirk
D
Haubitz
Marion
M
Witte
Torsten
T
Bange
Franz
F
Schmidt
Reinhold
R
Stoll
Matthias
M
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*
D000900:Anti-Bacterial Agents