Abstract
Introduction:Mycobacterium simiae is an atypical mycobacterium which can produce disseminated disease in patients with HIV and other immunodeficiency states. Herein, we describe a unique case of Mycobacterium simiae which presented initially as diarrhea with subsequent dissemination to the liver and spleen. Case Report: A 41-year-old Hispanic female on chemotherapy for acute promyelocytic leukemia presented with lower abdominal pain, diarrhea and fever of 102.2F. On physical examination, she had mild lower abdominal tenderness. Labs revealed a WBC count of 0.4 with 2% neutrophils and 98% lymphocytes; HIV test was negative. Patient was managed as neutropenic fever. Initial CT scan of abdomen was normal. She remained febrile despite being on broad spectrum antibacterial, antifungal and antiviral agents. Septic work-up (including bone marrow culture, whole body gallium scan and transesophageal echocardiogram were negative. Repeat CT scan performed a week after hospitalization revealed mesenteric lymphadenopathy, mostly in the left ileo-colic distribution. A follow-up scan two weeks later showed multiple tiny lucencies throughout the liver and spleen, consistent with microabscesses (see Figure). Stool culture at four weeks grew Mycobacterium simiae. Liver enzymes were persistently normal. Bacterial, fungal and AFB cultures of liver biopsy tissue were negative on two separate occasions. Quadruple antitubercular therapy was thereafter initiated with rapid defervescence and clinical improvement. Discussion: This case illustrates the importance of considering atypical mycobacteria when dealing with immunocompromised patients presenting with intractable fever. To our knowledge, this is the first reported case of hepatic microabscesses attributed to Mycobacterium simiae.Figure: [1038] CT scan abdomen showing multiple microabscesses throughout the liver and spleen.
Published Version
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