Spindle cell pseudotumor of the brain associated with Mycobacterium haemophilum and Mycobacterium simiae mixed infection in a patient with AIDS: the first case report.

BACKGROUND: Spindle cell pseudotumors may occur due to mycobacterial infection, especially in immunocompromised hosts including those with AIDS. They have been reported from many body sites; the lymph nodes are predominantly involved, most frequently associated with Mycobacterium avium complex infection. To the best of our knowledge, Mycobacterium-associated spindle cell pseudotumors have not been previously described in the brain stem and in association with mixed mycobacterial infection. CASE REPORT: We describe a man with AIDS who presented with right hemiparesis and truncal ataxia. Magnetic resonance imaging revealed enhancing nodular lesions at the cerebral peduncle and medulla. A mycobacterial spindle cell pseudotumor was diagnosed on surgical specimens. Blood and brain tissue cultures grew Mycobacterium haemophilum and Mycobacterium simiae. CONCLUSIONS: To our knowledge, this is the first case of spindle cell pseudotumor of the brain associated with M. haemophilum and M. simiae mixed infection.

Nontuberculous mycobacterial infections in King Chulalongkorn Memorial Hospital.

BACKGROUND: Nontuberculous mycobacteria (NTM) can cause infections in both human immunodeficiency virus (HIV)-infected and HIV-noninfected patients. The incidence of NTM infections has been increasing since the acquired immunodeficiency syndrome (AIDS) epidemics. However, the epidemiologic and clinical data of NTM infections in Thailand are limited. OBJECTIVE: Determine the epidemiology, clinical manifestations, treatment, and outcome of NTM infections in King Chulalongkorn Memorial Hospital from January 2000 to December 2003. MATERIAL AND METHOD: One hundred and fourteen patients had positive NTM cultures; however, complete medical records were available in only 103 (90.3%) patients. RESULTS: There were 71 (68.9%) HIV-infected patients, and 38 (87%) of them had the CD4 counts of < 200 cells/microL (range 4-360). Among HIV-infected patients, the most common previous opportunistic infections included tuberculosis (36.6%), Pneumocystis jirovecii pneumonia (25.3%), cryptococcal meningitis (15.5%), penicilliosis (5.6%), and cytomegalovirus infection (5.6%). Most patients presented with prolonged fever (67%), chronic cough (54.4%), lymphadenopathy (52.4%), weight loss (50.5%), or chronic diarrhea (31%). The clinical manifestations included disseminated (17.4%) and localized (82.6%) infections. The localized infection included pulmonary infection (82.3%), followed by gastrointestinal infection (34.1%), skin infection (12.9%), lymphadenitis (8.2%), genitourinary tract infection (2.4%), central nervous system infection (2.4%), and keratitis (1.2%). Mycobacterium avium complex (MAC) was the predominant species (48.5%), followed by M. kansasii (19.4%), and rapidly growing mycobacteria (16.4%). Diffuse reticular infiltration was most commonly observed on chest radiography (53.4%). Abnormal laboratory findings included anemia (48.5%), hyponatremia (42.7%), and elevated alkaline phosphatase (39.8%). The overall mortality rate was 34.8% (45.9% and 11.1% in HIV- and HIV-noninfected patients). CONCLUSION: A diagnosis of NTM infection requires a high index of suspicion in patients especially with AIDS or immunocompromised status who present with prolonged fever, with or without organ-specific symptoms and signs. Therefore, clinical specimens must be sent for mycobacterial cultures for a definite diagnosis, a determination of the species of NTM, and an appropriate management. In addition to four standard antituberculous drugs, clarithromycin should be added for the treatment of MAC in patients with AIDS who presented with disseminated opportunistic infections before obtaining the microbiologic results.

Rapidly growing mycobacteria in King Chulalongkorn Memorial Hospital and review of the literature in Thailand.

Rapidly growing mycobacteria (RGM) have emerged as important human pathogens that can cause a variety of diseases. Thirty isolates of the pathogenic RGM were recovered from patients who attended King Chulalongkorn Memorial Hospital during 1997 and 2003. There were 16 isolates of Mycobacterium chelonae, ten isolates of M. fortuitum and four isolates of M. abscessus. Clinical data was available in only nine patients (five males and four females) including six M. chelonae, two M. abscessus, and one M. fortuitum. The mean age was 37 years (range: 13-62 years). The associated conditions were present in five patients including two diabetes, one HIV infection, one pregnancy, one SLE and one chronic renal failure. A wide spectrum of clinical features was observed. These included two chronic pulmonary infections, two post-traumatic wound infections, two disseminated infections, one lymphadenitis, one keratitis and respiratory colonization. AFB staining was positive in six patients (66.67%). The MIC of one M. chelonae and one M. abscessus were determined by Epsilon test. For M. chelonae, the MIC of clarithromycin, amikacin, ciprofloxacin, sulfamethoxazole and imipenem were 0.25, 2.0, 1.00, > 64, and 0.54 microg/ml, respectively. For M. abscessus, the MIC of clarithromycin, amikacin, ciprofloxacin, tetracycline and sulfamethoxazole were 0.016, 0.016, 0.038, > 16 and 0.002 microg/ml, respectively. Six of eight patients (75%) were initially treated with four first-line antituberculous drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) before obtaining the culture result. Of these, three patients with pulmonary and disseminated infections improved after a prolonged course of these combinations. The patients improved after switching to specific anti-RGM antibiotics. One patient died after 10 months of therapy of four anti-tuberculous drugs. One patient with post-traumatic wound infection was cured with surgical debridement and dicloxacillin. One patient improved after treatment as acute bronchitis with oral amoxicillin. An extensive review of the literature of RGM infections in Thailand is also presented.