title: Hepatic granulomas as primary presentation of Mycobacterium avium infection in an HIV-negative, nonimmunosuppressed patient.
abstract: Nontuberculous hepatic granuloma in patients not infected by human immunodeficiency virus (HIV) is rare. We report an 89-year-old woman who presented with hepatic granuloma without lung involvement. Ultrasonography and computed tomography (CT) of the abdomen showed low-density lesions in the liver. Histopathological examination of a liver biopsy revealed florid, caseating granulomatous reaction with aggregates of epithelioid histiocytes and Langerhans-type giant cells in a predominantly portal and periportal distribution. Gastric juice cultures were positive for Mycobacterium avium. The patient was treated with antimycobacterial therapy. Her clinical condition improved dramatically within 1 month of starting therapy, with marked reduction in hepatomegaly together with normalization of liver biochemistry and CT findings.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, 6-100 Arai, Kitamoto, Saitama, 364-8501, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Toyoda
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, 6-100 Arai, Kitamoto, Saitama, 364-8501, Japan. yokomori@insti.kitasato-u.ac.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yokomori
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, 6-100 Arai, Kitamoto, Saitama, 364-8501, Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Kaneko
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, Kitamoto, Saitama, Japan.
authors.forename: Hide
authors.initials: H
authors.lastname: Yoshida
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, 6-100 Arai, Kitamoto, Saitama, 364-8501, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Takahashi
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, Kitamoto, Saitama, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Hoshi
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, 6-100 Arai, Kitamoto, Saitama, 364-8501, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Takeuchi
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, 6-100 Arai, Kitamoto, Saitama, 364-8501, Japan.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Tahara
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Kitasato Medical Center Hospital, Kitasato University, Kitamoto, Saitama, Japan.
authors.forename: Hirobumi
authors.initials: H
authors.lastname: Kondo
authors.affiliation: Division of Pathology, Kitasato Medical Center Hospital, Kitasato University, Kitamoto, Saitama, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Motoori
keywords: Hepatic granuloma; Immunocompetent host; Mycobacterium avium