Disseminated Mycobacterium avium and recurrent Salmonella group D infection in a patient with autoantibodies to interferon-gamma.
We reported a case of a 40-year-old woman who presented with prolonged fever for 1 month, left sternoclavicular arthritis, anemia, multiple cervical lymphadenopathy and hepatosplenomegaly. She had a previous history of recurrent Salmonella group D septicemia. Computed tomography of her chest and abdomen revealed left sternoclavicular (SC) arthritis, left subscapular collections, hepatosplenomegaly, and multiple hypodensed lesions in the spleen. Blood, synovial fluid and bone marrow for mycobacterial cultures identified Mycobacterium avium by real-time PCR and reverse hybridization. Cell mediated immunodeficiency investigations were strongly positive for autoantibodies to interferon-gamma (IFN-gamma) by ELISA technique. During the third week of antimycobacterial therapy, she developed an acute generalized pustular eruption. Skin biopsy showed leukocytoclastic vasculitis; drug allergy was suspected. The pustular eruption resolved with steroid treatment and discontinuation of levofloxacin and clarithromycin. She was discharged home after 8 weeks of hospitalization with azithromycin, rifampicin and ethambutol.
Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. thanet_bin@yahoo.co.th
Thanet
T
Chaisathaphol
Anupop
A
Jitmuang
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001323:Autoantibodies / Q000276:immunology*; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000276:immunology*; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D015269:Mycobacterium avium Complex; D060888:Real-Time Polymerase Chain Reaction; D012480:Salmonella Infections / Q000453:epidemiology*
D000900:Anti-Bacterial Agents; D001323:Autoantibodies; D007371:Interferon-gamma