Lorenzen Johan, Meyer-Olson Dirk, Haubitz Marion, Witte Torsten, Bange Franz, Schmidt Reinhold, Stoll Matthias
Department of Internal Medicine, Division of Nephrology, Hanover Medical School, Carl-Neuberg-Strasse 1, 30625, Hanover, Germany.
Clin Rheumatol. 2009 Jun;28 Suppl 1:S39-41. doi: 10.1007/s10067-009-1120-4. Epub 2009 Feb 28.
A 55-year-old woman with systemic lupus erythematosus was admitted with fever of unknown origin. She had been on an immunosuppressive regimen for the past 8 years including steroids and Azathioprine. Laboratory parameters revealed a markedly elevated C-reactive protein of 189 mg/l, antinuclear antibodies of 1:2,560, a hemoglobin level of 9.0 g/dl, and a severe lymphopenia (total lymphocytes 49.4/microl, CD4(+) cells 2/microl, CD8(+) cells 7/microl). Neither blood culture samples nor computed tomography and magnetic resonance imaging of the chest and abdomen nor a trans-esophageal echocardiography revealed positive results. A bone marrow biopsy did not show signs of hematologic disease, but revealed a small granuloma rife with acid-fast bacilli, which were later confirmed to be Mycobacterium genavense by gene sequencing. To our knowledge, this is the first case involving M. genavense infection in a patient with systemic lupus erythematosus. In contrast to other reports regarding disseminated M. genavense infection, the patient is still alive and well.
