We report the case of a 57-year-old woman with acquired immunodeficiency syndrome (AIDS) who was admitted to the emergency room with fever, diarrhea, and severe malnutrition (body mass index [BMI] 15.8 kg/m 2 ). Her history was notable for human immunodeficiency virus (HIV) infection with poor therapeutic adherence, which had been complicated by multiple opportunistic infections. Esophagogastroduodenoscopy and colonoscopy were macroscopically normal. A video capsule endoscopy was performed, which revealed diffuse jejunal atrophy, and whitish and edematous enteric mucosa with scalloping ( Video 1 ). Subsequently, anterograde double-balloon enteroscopy confirmed significant signs of atrophy with scalloping and a mosaic pattern in the jejunum ( Fig. 1 ). Subsequent histologic examination raised the suspicion of Mycobacterium avium complex (MAC) ( Fig. 2 ), which was confirmed afterward by polymerase chain reaction (PCR). Treatment was therefore initiated with rifabutin, azithromycin, and ethambutol with clinical improvement.
Fig. 1.
Image during anterograde double-balloon enteroscopy showing signs of atrophy, scalloping, and a mosaic pattern of the jejunum in a patient with Mycobacterium avium complex disease.
Fig. 2.
Histologic appearance showing: a ileal mucosa with diffusely enlarged villi (hematoxylin and eosin [H&E] stained; magnification × 40); b ileal lamina propria filled with histiocytes (CD68 immunostaining; × 200); c histiocytic cytoplasm full of periodic acid–Shiff (PAS)-positive bacilli (PAS stained; × 200).
Video capsule endoscopy showing diffuse jejunal atrophy, and whitish and edematous enteric mucosa with scalloping in a patient with Mycobacterium avium complex disease.
Video 1
Disseminated MAC is an infection caused by a nontuberculous mycobacterial species 1 , with this type usually associated with HIV infection; however, the widespread use of effective antiretroviral therapy and the use of prophylaxis against MAC infection have reduced the incidence of this illness 2 . This case describes a rare manifestation of an infrequent opportunistic infection that is typical of AIDS patients. In addition, we report detailed imaging and video documentation of a MAC-driven enteropathy to support endoscopists and clinicians in their everyday practice.
Endoscopy_UCTN_Code_CCL_1AB_2AH_3AB
Acknowledgement
This study was partially funded by the Italian Ministry of Health, Current Research IRCCS.
Footnotes
Conflict of Interest The authors declare that they have no conflict of interest.
Endoscopy E-Videos https://eref.thieme.de/e-videos .
E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos .
References
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