Department of Infectious Diseases, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojima-ku, Osaka, Osaka, 534-0021, Japan.
Department of Gastroenterology, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojima-ku, Osaka, Osaka, 534-0021, Japan.
AIDS Res Ther. 2021 Nov 29;18(1):90. doi: 10.1186/s12981-021-00417-0.
Disseminated Mycobacterium avium complex infection is an important indicator of acquired immunodeficiency syndrome (AIDS) in patients with advanced human immunodeficiency virus (HIV) infection. Effective antiretroviral therapy has dramatically reduced the incidence of and mortality due to HIV infection, although drug resistance and poor medication adherence continue to increase the risk of disseminated M. avium complex infection. However, gastrointestinal lesions in cases of disseminated M. avium complex infection resulting in protein-losing enteropathy have been rarely discussed. Therefore, we present a case of protein-losing enteropathy caused by disseminated M. avium complex infection in a patient undergoing antiretroviral therapy.
A 29-year-old man was diagnosed with AIDS 4 years ago and was admitted for a 10-month history of refractory diarrhea and fever. Despite receiving antiretroviral therapy, the viral load remained elevated due to poor medication adherence. The patient was diagnosed with disseminated M. avium complex infection and started on antimycobacterial drugs 2 years before admission. However, the infection remained uncontrolled. The previous hospitalization 1 year before admission was due to hypoalbuminemia and refractory diarrhea. Upper gastrointestinal endoscopy revealed a diagnosis of protein-losing enteropathy caused by intestinal lymphangiectasia, and treatment with intravenous antimycobacterial drugs did not resolve his intestinal lymphangiectasia. The patient inevitably died of sepsis.
Clinical remission is difficult to achieve in patients with AIDS and protein-losing enteropathy caused by disseminated M. avium complex infection due to limited options of parenteral antiretroviral drugs. This report highlights the importance of identifying alternative treatments (such as an injectable formulation) for patients who do not respond to antiretroviral therapy due to protein-losing enteropathy with disseminated M. avium complex infection.
播散性鸟分枝杆菌复合体感染是人类免疫缺陷病毒（HIV）感染晚期患者获得性免疫缺陷综合征（AIDS）的一个重要指标。有效的抗逆转录病毒治疗极大地降低了 HIV 感染的发病率和死亡率，尽管药物耐药性和药物依从性差仍在增加播散性鸟分枝杆菌复合体感染的风险。然而，播散性鸟分枝杆菌复合体感染导致蛋白丢失性肠病的胃肠道病变很少被讨论。因此，我们报告了一例接受抗逆转录病毒治疗的患者播散性鸟分枝杆菌复合体感染导致的蛋白丢失性肠病。
一名 29 岁男性，4 年前被诊断为 AIDS，并因难治性腹泻和发热入院 10 个月。由于药物依从性差，尽管接受了抗逆转录病毒治疗，但病毒载量仍居高不下。该患者被诊断为播散性鸟分枝杆菌复合体感染，并在入院前 2 年开始使用抗分枝杆菌药物。然而，感染仍未得到控制。入院前 1 年前的上一次住院是由于低白蛋白血症和难治性腹泻。上消化道内镜检查诊断为肠淋巴管扩张引起的蛋白丢失性肠病，静脉用抗分枝杆菌药物治疗未能解决其肠淋巴管扩张。患者最终死于脓毒症。
由于可供选择的肠外抗逆转录病毒药物有限，AIDS 患者和播散性鸟分枝杆菌复合体感染引起的蛋白丢失性肠病患者难以达到临床缓解。本报告强调了对于因播散性鸟分枝杆菌复合体感染引起的蛋白丢失性肠病而对抗逆转录病毒治疗无反应的患者，识别替代治疗方法（如注射制剂）的重要性。
