Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan.
Int J Infect Dis. 2010 Mar;14(3):e262-4. doi: 10.1016/j.ijid.2009.04.017. Epub 2009 Aug 4.
Disseminated infections with hemophagocytic syndrome caused by non-tuberculous mycobacteria (NTM) are rare. A 60-year-old woman, who presented with fever, chills, anorexia, and right upper quadrant pain, was admitted to our hospital. Hepatosplenomegaly, pancytopenia, elevated liver aminotransferases, and hyperferritinemia were noted after admission. A gallium scan and chest computed tomography revealed multiple mediastinal lymphadenopathy. A bone marrow examination revealed hemophagocytosis. Bone marrow and liver biopsies showed non-caseating granulomatosis and cultures from bone marrow and liver all yielded Mycobacterium kansasii. The patient responded well to azithromycin, isoniazid, rifampin, and ethambutol. No immunocompromised conditions such as malignancy, autoimmune disease, or HIV infection were detected initially. However, a right femoral tumor with pathological fracture was found five months later during follow-up at the outpatient clinic. Bone biopsy showed granulocytic sarcoma. To our knowledge, this is the first reported case of life-threatening hemophagocytosis due to M. kansasii. Patients with disseminated NTM infections should be closely monitored if any immunocompromising condition develops.
非结核分枝杆菌（NTM）引起的噬血细胞综合征的播散性感染较为罕见。一名 60 岁女性因发热、寒战、食欲不振和右上腹疼痛而入院。入院后发现肝脾肿大、全血细胞减少、肝转氨酶升高和血铁蛋白升高。镓扫描和胸部计算机断层扫描显示纵隔多部位淋巴结病。骨髓检查显示噬血细胞现象。骨髓和肝脏活检显示非干酪性肉芽肿，骨髓和肝脏培养均分离出堪萨斯分枝杆菌。患者对阿奇霉素、异烟肼、利福平、乙胺丁醇反应良好。最初未发现恶性肿瘤、自身免疫性疾病或 HIV 感染等免疫功能低下的情况。然而，在门诊随访 5 个月时，发现右侧股骨肿瘤伴病理性骨折。骨活检显示粒细胞肉瘤。据我们所知，这是首例由堪萨斯分枝杆菌引起的危及生命的噬血细胞综合征的报告病例。如果出现任何免疫功能低下的情况，应密切监测播散性 NTM 感染的患者。
