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

Am J Hematol. 1994 Apr;45(4):325-9. doi: 10.1002/ajh.2830450410.

Abstract

A 31-year-old woman presented with fever and arthralgia. Despite treatment with antimicrobials and corticosteroids, 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 avium-intracellulare (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. Hepatosplenomegaly and marked retroperitoneal lymphadenopathy were revealed, indicating further dissemination of MAI. Treatment with recombinant human GM-CSF and very-low-dose cytosine arabinoside, was started but was not effective. This case showed significant reduction in peripheral blood T-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 with MAI.

Publication types

  • Case Reports

MeSH terms

  • AIDS-Related Opportunistic Infections / immunology
  • Adult
  • Anemia, Refractory / complications*
  • Anemia, Refractory / drug therapy
  • Anemia, Refractory / microbiology
  • Bone Marrow / microbiology
  • CD4 Antigens / analysis
  • Cytarabine / therapeutic use
  • Dose-Response Relationship, Drug
  • Female
  • Gastric Juice / microbiology
  • Granulocyte-Macrophage Colony-Stimulating Factor / blood
  • Granulocyte-Macrophage Colony-Stimulating Factor / therapeutic use
  • Humans
  • Macrophage Colony-Stimulating Factor / therapeutic use
  • Mycobacterium avium-intracellulare Infection / complications*
  • Mycobacterium avium-intracellulare Infection / drug therapy
  • Mycobacterium avium-intracellulare Infection / immunology
  • Myelodysplastic Syndromes / complications*
  • Myelodysplastic Syndromes / drug therapy
  • Myelodysplastic Syndromes / microbiology
  • Recombinant Proteins / therapeutic use
  • T-Lymphocytes / immunology
  • T-Lymphocytes / pathology
  • Time Factors

Substances

  • CD4 Antigens
  • Recombinant Proteins
  • Cytarabine
  • Macrophage Colony-Stimulating Factor
  • Granulocyte-Macrophage Colony-Stimulating Factor