Disseminated, nonmeningeal gastrointestinal cryptococcal infection in an HIV-negative patient

Gastrointestinal cryptococcosis is extremely rare, especially in patients with no involvement of the central nervous system. We describe a 63-yr-old man undergoing prednisone therapy for chronic hepatitis and cirrhosis who presented with peritonitis, colitis, and skin lesions. Pathological studies revealed necrosis and numerous cryptococcal organisms in the colon, omentum, and skin, and cultures yielded Cryptococcus neoformans. The patient died of multisystem organ failure following emergency exploratory surgery performed when he had onset of symptoms of a bowel perforation after an endoscopic biopsy. Clinicians should be aware that gastrointestinal cryptococcosis can occur in the absence of infection of the central nervous system or lungs, and that it may affect relatively healthy patients who are immunocompromised because of splenectomy, chronic liver disease, or steroid therapy.     

Disseminated infection withSaccharomyces kluyveri in a patient with AIDS

A 47-year-old man with acquired immune deficiency syndrome was found to have disseminatedSaccharomyces kluyveri infection. The yeast was isolated from blood and cerebrospinal fluid. An autopsy revealed the presence of the microorganism in many organs including liver, kidneys, pancreas, spleen, lung, and brain. The case confirms a potential pathogenicity of yeasts of the genusSaccharomyces in patients with profound immune deficiency, especially in advanced HIV infection.     

Disseminated Mycobacterium marinum infection in a patient with diabetic nephropathy

A patient with diabetic nephropathy who presented with multiple tender subcutaneous nodules caused by Mycobacterium marinum infection is presented.     

Disseminated Mycobacterium chelonae infection in a patient with T-cell lymphoma

Infections with rapidly growing mycobacteria are rare and most often seen in immunocompromised patients. We herein present the case of a 69-year-old man with a T-cell lymphoma treated by chemotherapy and mogamulizumab with a 6-month history of febrile episodes and subcutaneous nodules in both arms and arthritis of metacarpophalangeal joints. Blood cultures and DNA sequencing results demonstrated the growth of Mycobacterium chelonae. The patient was successfully treated with clarithromycin, moxifloxacin, and tobramycin, but died shortly after due to lymphoma progression.     

Disseminated cutaneous Mycobacterium marinum infection in a patient with non-Hodgkin's lymphoma

A 60-year-old woman with non-Hodgkin's lymphoma was admitted to the hospital because of extensive subcutaneous abscesses developing on all limbs. The patient had an aquarium and kept tropical fish as pets. After repeated investigations, the diagnosis of Mycobacterium marinum was established from skin biopsy by PCR and culture. Long-term therapy with several drugs regimens had only a limited efficacy and was accompanied by severe adverse reactions. This report highlights the therapeutic problems posed by disseminated cutaneous M. marinum infection in the immunosuppressed host. Received: July 3, 2001 · Revision accepted: August 19, 2002 Ruxandra Enzensberger (corresponding author)     

Disseminated Mycobacterium malmoense infection in a patient with chronic granulocytic leukaemia

Abstract. Mycobacterium malmoense is an atypical mycobacterium previously isolated from lymph nodes in children and from adults with pulmonary disease. Disseminated infection is extremely rare and bone marrow involvement has never previously been described. We report a patient with chronic granulocytic leukaemia and persistent fever with granuloma in the bone marrow due to disseminated M. malmoense infection. The patient initially received treatment with isoniazid, ethambutol and rifampicin with clearance of mycobacteria in the bone marrow and clinical improvement. Sensitivity in vitro was established for streptomycin, amikacin, ethambutol and rifabutin. The patient eventually expired as a result of progressive respiratory failure from other opportunistic infections. At autopsy staining of samples from lung parenchyma revealed fungal hyphi but staining for Pneumocystis carinii and myobacteria were negative.     

Disseminated Ochroconis gallopava infection in a heart transplant patient

Ochroconis gallopava is an emerging cause of mycosis in solid organ transplant recipients. Herein, we report a rare case of disseminated O. gallopava infection that involved lung, subcutaneous area, brain and peritoneum in a heart transplant recipient. Despite voriconazole therapy, the patient died 2 months after diagnosis.     

Disseminated Mycobacterium avium complex infection in a patient with autoantibody to interferon-gamma

A 54-year-old man was admitted to our hospital because of intermittent high fever, general malaise, cough and body weight loss after he had been examined and treated at the former hospital for 3 years without a definitive diagnosis and effective therapy. Bacterial examination on admission revealed Streptococcus pyogenes in peripheral blood, bone marrow aspirates and pleural effusion. Furthermore, Mycobacterium avium complex (MAC) was detected in sputum, gastric juice, bone marrow liquid, pleural effusion by acid-fast bacillus culture or polymerase chain reaction (PCR). Biopsy of the neck lymph node showed multiple granulomas and the presence of acid-fast bacilli. Administration of ABPC/SBT and later CLDM resulted in disappearance of Streptococcus pyrogenes after 2 weeks. We suspected of generalized immunodeficiency that might underlie the severe bacteremia/osteomyelitis and disseminated MAC infection. We tested interferon (IFN)-gamma production of peripheral blood mononuclear cells (PBMC) of the patient after phytohemagglutinin (PHA)-stimulation and found that these cells produced no or undetectable levels of IFN-gamma in the presence of autologous plasma while produced almost normal levels of IFN-gamma in the presence of healthy donor's plasma. Since this neutralizing activity was co-purified in the IgG fraction, the immunodeficient state of the patient seemed to be caused by autoantibody to IFN-gamma. As far as we know, this is the first report of a Japanese case of disseminated MAC infection presumably due to autoantibody to IFN-gamma.     

Disseminated Sporothrix schenckii infection with arthritis in a patient with acquired immunodeficiency syndrome

Patients with the acquired immune deficiency syndrome are susceptible to a wide spectrum of opportunistic infections. We report a 34-year-old man who developed systemic sporotrichosis involving the skin and joints, and whose illness terminated in subacute encephalopathy and Pneumocystis carinii pneumonia. Fungal arthritis is another infection to which patients with this syndrome are subject.     

Disseminated Ureaplasma urealyticum infection in a hypo-gammaglobulinaemic renal transplant patient

We report of a case of severe disseminated U. urealyticum infection in a 35-y-old kidney transplanted patient with CVID. Routine microbiological tests were negative. Six weeks after admission, abscess material was grown on Mycoplasma culture medium yielding U. urealyticum in high titres. The patient responded promptly to appropriate antibiotics.