Disseminated Mycobacterium genavense infection mimicking TAFRO syndrome.

Published on Jul 16, 2020in Journal of Infection and Chemotherapy1.722
· DOI :10.1016/J.JIAC.2020.06.020
Kosuke Oka2
Estimated H-index: 2
(Okayama University),
Mai Yamane (Okayama University)+ 6 AuthorsFumio Otsuka35
Estimated H-index: 35
(Okayama University)
Sources
Abstract
Abstract TAFRO syndrome is a rare variant of idiopathic multicentric Castleman's disease, for which disseminated non-tuberculous mycobacteria (NTM) infection must be excluded. However, due to the slow and fastidious growth of the organisms, identification of the pathogen is often challenging. We herein describe a case of disseminated Mycobacterium genavence infection, in which manifestations of the patient were confusingly similar to those of TAFRO syndrome. A 69-year-old Japanese man presented with prolonged fever accompanying pain in his back and ribs on the right side. Systemic investigations revealed thrombocytopenia, marked elevation of alkaline phosphatase, anasarca (pleural effusion and ascites), megakaryocytosis in the bone marrow, and hepatomegaly. Magnetic resonance imaging (MRI) showed diffuse, T1-and T2-low-intensity spotted lesions on his vertebral bodies, but biopsy showed inconclusive results. The patient met the diagnostic criteria of TAFRO syndrome and was started on prednisolone, which improved his general condition shortly thereafter. Blood culture after 42 days of incubation revealed the presence of Mycobacterium; however, we considered it a contamination at that time because no organisms grew on conventional agars, and the patient was discharged. Ten weeks after the isolation of Mycobacterium, he developed persistent fever and was readmitted. This time, vertebral bone mallow biopsy demonstrated a large amount of mycobacterium, which was later successfully identified as M. genavense by sequencing analysis. Under a final diagnosis of disseminated M. genavense infection, we treated the patient with clarithromycin, rifampicin, and ethambutol. This case highlighted that disseminated NTM infection may follow a similar clinical course as that of TAFRO syndrome.
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BACKGROUND: Although thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly (TAFRO) syndrome was first described as a variant of idiopathic multicentric Castleman disease, patients with TAFRO syndrome have more aggressive clinical features. Because these patients may present with fever of unknown origin, general physicians need to recognize its characteristic laboratory data and clinical features during hospitalization. AIMS: Herein, we described the features, symptoms, and char...
6 CitationsSource
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This article presents a case of an HIV-infected paediatric patient with an unusual Mycobacterium genavense infection with predominantly abdominal organ involvement.
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Abstract Mycobacterium genavense (M. genavense) is one of the most fastidious, difficult to culture Mycobacterium species. Patients infected with human immunodeficiency virus (HIV) may develop immune reconstitution inflammatory syndrome (IRIS) due to disseminated M. genavense infection as well as disseminated M. avium and intracellulare complex infection. Consensus regarding treatment of IRIS due to disseminated mycobacterium infection has not yet been obtained, although systemic steroid therapy...
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Abstract Objective Anti-interferon- γ (IFN-γ) autoantibodies (anti-IFN-γ Abs) have been increasingly recognized as an important cause of disseminated nontuberculous mycobacterial (DNTM) infection, and identification of this immunodeficiency impacts clinical management. However, the protean disease manifestations and inaccessibility to diagnostic tests in clinical settings hamper its early diagnosis. Here, we sought to determine whether QuantiFERON-TB Gold In-tube (QFT-GIT), a commercialized IFN-...
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This paper evaluates the capability of MicroSeq 500 instrument to improve the diagnosis of Mycobacterium genavense The strain was isolated from a two year old child admitted to our hospital for hepatosplenomegaly and massive abdominal lymphadenopathies. DNA was extracted from a lymph node and examined by amplifying 500 bp at the 5' end of 16S rRNA gene using MicroSeq 500 16S rDNA Bacterial Identification PCR kit. Sequencing reactions were performed with MicroSeq 500 16S rDNA Bacterial Identifica...
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#1Yoshito Nishimura (U.H.: University of Hawaii at Manoa)
#1Yoshito Nishimura (Okayama University)H-Index: 5
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Thrombocytopenia, anasarca, fever, reticulin fibrosis, renal insufficiency, and organomegaly (TAFRO) syndrome is a heterogeneous entity manifesting with a constellation of symptoms described above that can occur in the context of idiopathic multicentric Castleman disease (iMCD) as well as infectious diseases, malignancies, and rheumatologic disorders. So, iMCD-TAFRO is an aggressive subtype of iMCD with TAFRO syndrome and often hyper-vascularized lymph nodes. Since we proposed diagnostic criteri...
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#1Chang-Tsu Yuan (NTU: National Taiwan University)H-Index: 3
Last. Un-In WuH-Index: 17
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Early recognition of adult-onset immunodeficiency associated with neutralizing anti-interferon gamma autoantibodies (anti-IFNγ Abs) remains difficult, and misdiagnoses have been reported. Although febrile lymphadenopathy is among the most common initial manifestations of this disorder, no comprehensive clinicopathologic analysis of lymphadenopathy in patients with anti-IFNγ Abs has been reported. Here, we describe 26 lymph node biopsy specimens from 16 patients. All patients exhibited concurrent...
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