Long-term remission for disseminated Mycobacterium avium-intracellulare complex associated with antibody deficiency

Mycobacterium avium-intracellulare (MAI) is a ubiquitous organism with limi ted virulence in the immunocompetent host. Disseminated disease is associat ed with a high mortality rate. Except for localized cervical adenitis, MAI disease is rare in immunocompetent children. We report a child with antibod y deficiency (dysgammaglobulinemia) and disseminated MAI infection, in whom complete, long-term remission was attained with multiple antimycobacterial therapy. The patient presented with progressive cervical lymphadenopathy and hepatom egaly at 7 years of age. A lymph node biopsy showed acid-fast bacilli and g ranulomas. Despite a transient response to conventional antituberculous the rapy, including isoniazid and rifampin, his symptoms progressed. Cultures f rom blood, bone marrow, spleen, and cervical lymph node tissues revealed an MAI organism. Subsequent treatment using a combination of clarithromycin, amikacin, and ethambutol for 16 months resolved clinical symptoms, and subs equent blood culture results became negative. By the time of this report, t he patient has been disease-free for 4 years. Multiple-drug therapy is promising for the treatment of MAI in children wit h antibody deficiency; however, the selection of antiinfective drugs should include a member of the newer macrolide family.