title: Nontuberculous Mycobacterial Infection in the Uterine Cervix Mimics Invasive Cervical Cancer in Immunocompetent Woman.
abstract: Nontuberculous mycobacterial (NTM) infection is increasing across the world. Although the most common clinical manifestation of NTM disease is lung disease, a rare form of disseminated NTM disease has also been documented. Disseminated NTM usually develops in severely immunocompromised individuals, especially those with advanced AIDS. This manifestation is rare in non-HIV-infected hosts and is associated with immunosuppressed conditions. However, recent reports have suggested that disseminated NTM disease in immunocompetent patients without HIV infection has been increasing. Dissemination may involve any organ system, but a case in the female genital tract has never been reported. We report a case in a 67-yr-old previously healthy woman who presented with a disseminated NTM infection in the uterine cervix. The primary presentation was general fatigue and body weight loss. The patient also presented with a mass formation that mimicked cervical cancer on magnetic resonance imaging. In addition to the cervical mass, the patient presented with a mass formation in the omentum; wall thickening of the vagina, bladder, and ureter; and retention of pleural/peritoneal fluid. Vaginal cytology was negative. A diagnosis was made only after detecting acid-fast bacilli in a biopsy specimen of cervical mass, which was conducted under suspicion of cervical malignancy. Then, Mycobacterium avium was confirmed in a polymerase chain reaction test of cervical tissue. After administration of antimycobacterial therapy, the mass and other findings on magnetic resonance imaging disappeared. Infection in multiple organs leads to the diagnosis of disseminated NTM. This case indicates that, for prompt and accurate diagnosis, efforts to detect specific lesions by an imaging study and to confirm diagnosis pathologically are equally important, especially when local cytology is not convincing. The clinical course of this case may serve as a useful reference in the diagnosis and treatment of NTM.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Kinki University, Osakasayama, Osaka, Japan.
authors.forename: Masayo
authors.initials: M
authors.lastname: Ukita
authors.forename: Masato
authors.initials: M
authors.lastname: Aoki
authors.forename: Kosuke
authors.initials: K
authors.lastname: Murakami
authors.forename: Hisamitsu
authors.initials: H
authors.lastname: Takaya
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kotani
authors.forename: Masao
authors.initials: M
authors.lastname: Shimaoka
authors.forename: Takako
authors.initials: T
authors.lastname: Tobiume
authors.forename: Hidekatsu
authors.initials: H
authors.lastname: Nakai
authors.forename: Isao
authors.initials: I
authors.lastname: Tsuji
authors.forename: Ayako
authors.initials: A
authors.lastname: Suzuki
authors.forename: Masaki
authors.initials: M
authors.lastname: Mandai
mesh_terms: D000368:Aged; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D002584:Cervix Uteri / Q000382:microbiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis* / Q000188:drug therapy; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis
chemical_list: D000904:Antibiotics, Antitubercular