Disseminated mycobacterium avium-intracellulare infection in a patient with myelodysplastic syndrome (refractory anemia)

✍ Scribed by Hiroko Tsukada; Takaaki Chou; Yasuo Ishizuka; Osamu Ogawa; Takako Saeki; Satoshi Ito; Masaya Wakabayashi; Naoki Hayashi; Masaaki Arakawa

• Publisher: John Wiley and Sons
• Year: 1994
• Tongue: English
• Weight: 464 KB
• Volume: 45
• Category: Article
• ISSN: 0361-8609
• DOI: 10.1002/ajh.2830450410

✦ Synopsis

A 31-year-old woman presented with fever and arthralgla. Despite treatment with antimicrobials and cortlcosteroids, her symptoms persisted. A diagnosis of myelodysplastic syndrome (MDS)-refractory anemia (RA) was made by pancytopenia, dysplasia, and trisomy 8. Cultures of bone marrow, blood, and gastric juice showed Mycobacterium eviumlntraceliuiare (MAI). She was treated with antimycobacterial drugs and recombinant human G-CSF/M-CSF and showed an initial response, but spike fever recurred and pancytopenia progressed. Hepatospienomegaly and marked retroperitoneal lymphadenopathy were revealed, indicating further dissemination of MAI. Treatment wlth recombinant human GM-CSF and very-low-dose cytoslne arabinoside, was started but was not effective. This case showed significant reduction In peripheral blood 1-lymphocytes, especially the CD4+ population, and low immunoglobulin levels. immunodeficiency state associated with long-term steroid therapy and MDS seemed to contribute to the development of the disseminated infection wlth YAI.