title: Disseminated mycobacterium avium complex as protein-losing enteropathy in a non-HIV patient.
abstract: Disseminated mycobacterium avium complex (MAC) causing protein-losing enteropathy (PLE) due to intestinal lymphangiectasia (IL) in a non-HIV immunocompromised state is extremely rare. We present a case of 56-year-old male who was evaluated for worsening dyspnea and found to have right-sided chylous pleural effusion as well as worsening abdominal and retroperitoneal lymphadenopathy. He had a history of psoriasis for which hewas on etanercept and alefacept which were stopped two years prior to the presentation. The evaluation revealed a MAC infection in his lymph nodes--a low CD4 count but negative for HIV. He was started on MAC therapy. He subsequently developed noninfectious diarrhea, Hypoalbuminemia, recurrentpleural effusions, ascites, and Pneumocystis jiroveci pneumonia (PJP). Despite appropriate antibiotics and management--including total parental nutrition (TPN) with a medium-chain triglyceride enriched low fat diet--the patient's clinical condition deteriorated rapidly resulting in death.
authors: Venkata Rajesh
authors: VR
authors: Konjeti
authors: Sravanthi
authors: S
authors: Paluri
mesh_terms: D000904:Antibiotics, Antitubercular / Q000008:administration & dosage; D001706:Biopsy; D018791:CD4 Lymphocyte Count; D002915:Chylous Ascites / Q000000981:diagnostic imaging / Q000209:etiology; D017291:Clarithromycin / Q000008:administration & dosage*; D004977:Ethambutol / Q000008:administration & dosage*; D017809:Fatal Outcome; D006801:Humans; D008201:Lymphangiectasis, Intestinal / Q000150:complications / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex / Q000302:isolation & purification; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology; D011504:Protein-Losing Enteropathies / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D012293:Rifampin / Q000008:administration & dosage*; D012709:Serum Albumin / Q000032:analysis; D014057:Tomography, X-Ray Computed
chemical_list: D000904:Antibiotics, Antitubercular; D012709:Serum Albumin; D004977:Ethambutol; D017291:Clarithromycin; D012293:Rifampin