Disseminated Mycobacterium genavense infection in a patient with acquired immunodeficiency syndrome: First case report in Taiwan

Mycobacterium genavense is a recently described fastidious mycobacterium id entified as a pathogen causing disseminated infection in patients with adva nced human immunodeficiency virus (HIV) disease. In this report, we describ e the first reported case of disseminated M. genavense infection in a patie nt with acquired immunodeficiency syndrome (AIDS) in Taiwan. A 22-year-old Chinese man was found to be seropositive for HIV at age 18, in 1993. In 199 7, he presented with abdominal pain, weight loss, low CD4 lymphocyte count, hepatomegaly, and generalized lymphadenopathy. Microscopic examination of a biopsy specimen from an inguinal lymph node showed both ill- and well-for med noncaseating granulomas. Numerous acid-fast bacilli were present in the histiocyte cytoplasm. Although the organism did not grow on conventional s olid media used in our laboratory, two molecular biology techniques, includ ing polymerase chain reaction (PCR) followed by sequencing of 16S rRNA, and PCR together with restriction enzyme fragment polymorphism analysis, confi rmed the M. genavense infection. The patient's abdominal symptoms responded well to a chemotherapy regimen that included ethambutol, ciprofloxacin,and clarithromycin, and he survived more than 6 months after diagnosis. Howeve r, the lymphadenopathy was still present at his final follow-up. Our report indicates that disseminated infection with M. genavense should be added to the list of differential diagnoses of secondary infections in advanced AID S patients in Taiwan.