       Document 0302
 DOCN  M9610302
 TI    [Massive and progressive hepatosplenomegaly caused by disseminated
       nontuberculous mycobacteriosis in a patient with acquired
       immunodeficiency syndrome]
 DT    9601
 AU    Hagiwara T; Amano K; Sugimura D; Isogai N; Arai M; Fukutake K; Kojima H;
       Shimada H; Department of Clinical Pathology, Tokyo Medical College,
       Japan.
 SO    Kekkaku. 1995 Jul;70(7):423-9. Unique Identifier : AIDSLINE MED/96047777
 AB    A 28-year-old hemophilia A patient was admitted to our hospital in July,
       1991 because of high fever, chronic diarrhea and anemia. The patient had
       been recognized as a asymptomatic carrier of human immunodeficiency
       virus (HIV) in 1985 and had developed Pneumocystis carinii pneumonia and
       had been diagnosed as acquired immunodeficiency syndrome (AIDS) in 1990.
       Hematologic laboratory examinations on admission revealed pancytopenia
       and a CD4+ cell count of 3/mm3. X-ray findings of chest and abdomen were
       normal and bacterial cultures of sputum, urine, blood, stool,
       cerebrospinal fluid and bone marrow yielded no pathogenic
       microorganisms. Microscopical examination of the stained specimens
       showed no acid-fast bacilli. On his fifth hospital day, his liver and
       spleen enlarged markedly and an abdominal CT scan obtained on the 13th
       day revealed high-grade hepatosplenomegaly. Administration of several
       kinds of antibiotics, antifungal agents, antiviral agents,
       antituberculous agents and gamma-globulin medicines did not relieve the
       symptoms. On the 28th day the patient had developed a subarachnoid
       hemorrhage and died five days later. Retrospectively all cultures for
       acid-fast bacilli of the specimens on his admission yielded
       nontuberculous mycobacteria. The bacteria were identified as
       Mycobacterium avium by polymerase chain reaction and his disease was
       eventually diagnosed as disseminated Mycobacterium avium complex (MAC)
       infection. The liver and spleen weighed 2,660 g and 1,840 g respectively
       at autopsy. Although hepatosplenomegaly is commonly recognized in AIDS
       patients with disseminated MAC infection, such massive and rapid
       enlargement has been rarely observed. This case study emphasize the
       importance of diagnosis and rapid treatment at the early stage of MAC
       infection.
 DE    Acquired Immunodeficiency Syndrome/*COMPLICATIONS  Adult  AIDS-Related
       Opportunistic Infections/*COMPLICATIONS/DIAGNOSIS  Case Report  English
       Abstract  Hemophilia/COMPLICATIONS  Hepatomegaly/*ETIOLOGY  Human  Male
       Mycobacterium avium Complex/ISOLATION & PURIF  Mycobacterium
       avium-intracellulare Infection/*COMPLICATIONS/  DIAGNOSIS  Pneumonia,
       Pneumocystis carinii/COMPLICATIONS  Polymerase Chain Reaction
       Splenomegaly/*ETIOLOGY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

