Protein-losing enteropathy caused by disseminated Mycobacterium avium complex infection in a patient receiving antiretroviral therapy: an autopsy case report

Abstract Background Disseminated Mycobacterium avium complex infection is an important indicator of acquired immunodeficiency syndrome (AIDS) in patients with advanced human immunodeficiency virus (HIV) infection. Effective antiretroviral therapy has dramatically reduced the incidence of and mortali...

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Autores principales:	Keiji Konishi, Hidenori Nakagawa, Akio Nakahira, Takahiro Okuno, Takeshi Inoue, Michinori Shirano
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Disseminated Mycobacterium avium complex infection Protein-losing enteropathy Antiretroviral therapy Acquired immunodeficiency syndrome Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/77eb5c8c1c704cb08a224fde7e098805
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spelling	oai:doaj.org-article:77eb5c8c1c704cb08a224fde7e0988052021-12-05T12:05:53ZProtein-losing enteropathy caused by disseminated Mycobacterium avium complex infection in a patient receiving antiretroviral therapy: an autopsy case report10.1186/s12981-021-00417-01742-6405https://doaj.org/article/77eb5c8c1c704cb08a224fde7e0988052021-11-01T00:00:00Zhttps://doi.org/10.1186/s12981-021-00417-0https://doaj.org/toc/1742-6405Abstract Background Disseminated Mycobacterium avium complex infection is an important indicator of acquired immunodeficiency syndrome (AIDS) in patients with advanced human immunodeficiency virus (HIV) infection. Effective antiretroviral therapy has dramatically reduced the incidence of and mortality due to HIV infection, although drug resistance and poor medication adherence continue to increase the risk of disseminated M. avium complex infection. However, gastrointestinal lesions in cases of disseminated M. avium complex infection resulting in protein-losing enteropathy have been rarely discussed. Therefore, we present a case of protein-losing enteropathy caused by disseminated M. avium complex infection in a patient undergoing antiretroviral therapy. Case presentation A 29-year-old man was diagnosed with AIDS 4 years ago and was admitted for a 10-month history of refractory diarrhea and fever. Despite receiving antiretroviral therapy, the viral load remained elevated due to poor medication adherence. The patient was diagnosed with disseminated M. avium complex infection and started on antimycobacterial drugs 2 years before admission. However, the infection remained uncontrolled. The previous hospitalization 1 year before admission was due to hypoalbuminemia and refractory diarrhea. Upper gastrointestinal endoscopy revealed a diagnosis of protein-losing enteropathy caused by intestinal lymphangiectasia, and treatment with intravenous antimycobacterial drugs did not resolve his intestinal lymphangiectasia. The patient inevitably died of sepsis. Conclusions Clinical remission is difficult to achieve in patients with AIDS and protein-losing enteropathy caused by disseminated M. avium complex infection due to limited options of parenteral antiretroviral drugs. This report highlights the importance of identifying alternative treatments (such as an injectable formulation) for patients who do not respond to antiretroviral therapy due to protein-losing enteropathy with disseminated M. avium complex infection.Keiji KonishiHidenori NakagawaAkio NakahiraTakahiro OkunoTakeshi InoueMichinori ShiranoBMCarticleDisseminated Mycobacterium avium complex infectionProtein-losing enteropathyAntiretroviral therapyAcquired immunodeficiency syndromeImmunologic diseases. AllergyRC581-607ENAIDS Research and Therapy, Vol 18, Iss 1, Pp 1-5 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Disseminated Mycobacterium avium complex infection Protein-losing enteropathy Antiretroviral therapy Acquired immunodeficiency syndrome Immunologic diseases. Allergy RC581-607
spellingShingle	Disseminated Mycobacterium avium complex infection Protein-losing enteropathy Antiretroviral therapy Acquired immunodeficiency syndrome Immunologic diseases. Allergy RC581-607 Keiji Konishi Hidenori Nakagawa Akio Nakahira Takahiro Okuno Takeshi Inoue Michinori Shirano Protein-losing enteropathy caused by disseminated Mycobacterium avium complex infection in a patient receiving antiretroviral therapy: an autopsy case report
description	Abstract Background Disseminated Mycobacterium avium complex infection is an important indicator of acquired immunodeficiency syndrome (AIDS) in patients with advanced human immunodeficiency virus (HIV) infection. Effective antiretroviral therapy has dramatically reduced the incidence of and mortality due to HIV infection, although drug resistance and poor medication adherence continue to increase the risk of disseminated M. avium complex infection. However, gastrointestinal lesions in cases of disseminated M. avium complex infection resulting in protein-losing enteropathy have been rarely discussed. Therefore, we present a case of protein-losing enteropathy caused by disseminated M. avium complex infection in a patient undergoing antiretroviral therapy. Case presentation A 29-year-old man was diagnosed with AIDS 4 years ago and was admitted for a 10-month history of refractory diarrhea and fever. Despite receiving antiretroviral therapy, the viral load remained elevated due to poor medication adherence. The patient was diagnosed with disseminated M. avium complex infection and started on antimycobacterial drugs 2 years before admission. However, the infection remained uncontrolled. The previous hospitalization 1 year before admission was due to hypoalbuminemia and refractory diarrhea. Upper gastrointestinal endoscopy revealed a diagnosis of protein-losing enteropathy caused by intestinal lymphangiectasia, and treatment with intravenous antimycobacterial drugs did not resolve his intestinal lymphangiectasia. The patient inevitably died of sepsis. Conclusions Clinical remission is difficult to achieve in patients with AIDS and protein-losing enteropathy caused by disseminated M. avium complex infection due to limited options of parenteral antiretroviral drugs. This report highlights the importance of identifying alternative treatments (such as an injectable formulation) for patients who do not respond to antiretroviral therapy due to protein-losing enteropathy with disseminated M. avium complex infection.
format	article
author	Keiji Konishi Hidenori Nakagawa Akio Nakahira Takahiro Okuno Takeshi Inoue Michinori Shirano
author_facet	Keiji Konishi Hidenori Nakagawa Akio Nakahira Takahiro Okuno Takeshi Inoue Michinori Shirano
author_sort	Keiji Konishi
title	Protein-losing enteropathy caused by disseminated Mycobacterium avium complex infection in a patient receiving antiretroviral therapy: an autopsy case report
title_short	Protein-losing enteropathy caused by disseminated Mycobacterium avium complex infection in a patient receiving antiretroviral therapy: an autopsy case report
title_full	Protein-losing enteropathy caused by disseminated Mycobacterium avium complex infection in a patient receiving antiretroviral therapy: an autopsy case report
title_fullStr	Protein-losing enteropathy caused by disseminated Mycobacterium avium complex infection in a patient receiving antiretroviral therapy: an autopsy case report
title_full_unstemmed	Protein-losing enteropathy caused by disseminated Mycobacterium avium complex infection in a patient receiving antiretroviral therapy: an autopsy case report
title_sort	protein-losing enteropathy caused by disseminated mycobacterium avium complex infection in a patient receiving antiretroviral therapy: an autopsy case report
publisher	BMC
publishDate	2021
url	https://doaj.org/article/77eb5c8c1c704cb08a224fde7e098805
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Protein-losing enteropathy caused by disseminated Mycobacterium avium complex infection in a patient receiving antiretroviral therapy: an autopsy case report

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