RESUMO
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.
Assuntos
Claritromicina/administração & dosagem , Etambutol/administração & dosagem , Linfangiectasia Intestinal , Infecção por Mycobacterium avium-intracellulare , Enteropatias Perdedoras de Proteínas , Rifampina/administração & dosagem , Antibióticos Antituberculose/administração & dosagem , Biópsia , Contagem de Linfócito CD4 , Ascite Quilosa/diagnóstico por imagem , Ascite Quilosa/etiologia , Evolução Fatal , Humanos , Linfangiectasia Intestinal/complicações , Linfangiectasia Intestinal/microbiologia , Linfangiectasia Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/complicações , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Infecção por Mycobacterium avium-intracellulare/fisiopatologia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Enteropatias Perdedoras de Proteínas/sangue , Enteropatias Perdedoras de Proteínas/diagnóstico , Enteropatias Perdedoras de Proteínas/tratamento farmacológico , Enteropatias Perdedoras de Proteínas/etiologia , Enteropatias Perdedoras de Proteínas/fisiopatologia , Albumina Sérica/análise , Tomografia Computadorizada por Raios XRESUMO
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.