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.
Subject(s)
Clarithromycin/administration & dosage , Ethambutol/administration & dosage , Lymphangiectasis, Intestinal , Mycobacterium avium-intracellulare Infection , Protein-Losing Enteropathies , Rifampin/administration & dosage , Antibiotics, Antitubercular/administration & dosage , Biopsy , CD4 Lymphocyte Count , Chylous Ascites/diagnostic imaging , Chylous Ascites/etiology , Fatal Outcome , Humans , Lymphangiectasis, Intestinal/complications , Lymphangiectasis, Intestinal/microbiology , Lymphangiectasis, Intestinal/pathology , Male , Middle Aged , Mycobacterium avium Complex/isolation & purification , Mycobacterium avium-intracellulare Infection/complications , Mycobacterium avium-intracellulare Infection/diagnosis , Mycobacterium avium-intracellulare Infection/drug therapy , Mycobacterium avium-intracellulare Infection/physiopathology , Pleural Effusion/diagnostic imaging , Pleural Effusion/etiology , Protein-Losing Enteropathies/blood , Protein-Losing Enteropathies/diagnosis , Protein-Losing Enteropathies/drug therapy , Protein-Losing Enteropathies/etiology , Protein-Losing Enteropathies/physiopathology , Serum Albumin/analysis , Tomography, X-Ray ComputedABSTRACT
The current study was designed to test the role of bacterial overgrowth in the small intestine in the pathogenesis of chronic pancreatitis. It was established that the bacterial overgrowth in the small intestine is noted in the majority of patients with chronic pancreatitis. We found an association between clinical manifestations of chronic pancreatitis, active duodenitis, duodenal lymphangiectasia and papillitis and bacterial overgrowth in the small intestine.
