Abstract
Infections by opportunistic non-tuberculous mycobacteria (NTM) are rising in global incidence. One emerging, slowly growing NTM is Mycobacterium haemophilum, which can cause skin, lung, bone, and soft tissue infections in immunocompromised patients as well as lymphadenitis in immunocompetent individuals. Detection of this microorganism is difficult using conventional culture-based methods and few reports have documented involvement of this pathogen within the central nervous system (CNS).We describe the neuropathologic autopsy findings of a 39-year-old man with AIDS who died secondary to M. haemophilum CNS infection. He initially presented with repeated bouts of pyrexia, nausea and vomiting, and altered mental status that required numerous hospitalizations. CSF infectious workups were consistently negative. His most recent admission identified hyperintensities within the brainstem by MRI and despite antibiotic therapies for suspected CNS infection, he died. Autopsy revealed a swollen brain with marked widening of the brainstem. Microscopic examination of the brain and spinal cord showed focal lymphohistiocytic infiltrates, gliosis and neuronal loss that were associated with acid-fast bacilli (AFB). The brainstem was the most severely damaged and AFB were found to congregate along arterial territories lending support to the notion of hematogenous spread as a mechanism for the organisms’ dissemination. 16S rRNA sequencing on formalin-fixed paraffin-embedded tissue enabled post-mortem identification of M. haemophilum. This sequencing methodology may permit diagnosis on CSF intra-vitam.
Highlights
Non-tuberculous mycobacterial (NTM) infections are generally seen in patients with impaired cell-mediated immunity but can be found in patients without underlying disease [1]
M. haemophilum infection within the central nervous system (CNS) is rare and, to our knowledge, only six reports in the English literature have described the neuropathologic findings of the infection, all of which are based on surgical biopsy material [7,8,9,10,11,12,13]
We describe the postmortem neuropathologic findings of an AIDS patient
Summary
Non-tuberculous mycobacterial (NTM) infections are generally seen in patients with impaired cell-mediated immunity but can be found in patients without underlying disease [1]. Included in this category of NTM is Mycobacterium haemophilum, which is a slowgrowing, acid-fast bacillus that is recognized to cause cutaneous, pulmonary, bone, and joint infections [2, 3]. * Correspondence: rh2850@cumc.columbia.edu 1Department of Pathology & Cell Biology, Columbia University Irving Medical Center, New York, NY 10032, USA Full list of author information is available at the end of the article
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