Hn. Nguyen et al., Severe gastrointestinal hemorrhage due to mycobacterium avium complex in apatient receiving immunosuppressive therapy, AM J GASTRO, 94(1), 1999, pp. 232-235
Intense immunosuppressive therapy is used frequently for treatment of syste
mic vasculitides, collagenoses, rapidly progressive glomerulonephritis, and
after organ transplantation. Numerous serious treatment-related side effec
ts include localized or disseminated opportunistic infections, and require
careful monitoring of immunosuppressed patients. Gastrointestinal infection
s with Mycobacterium avium complex (MAC) or other nontuberculous mycobacter
ia have been previously identified in HIV seropositive patients only. We no
w report the first case of an HIV seronegative patient who received immunos
uppressive therapy for rapidly progressive glomerulonephritis. The patient
presented with severe lower gastrointestinal bleeding and was diagnosed to
have ulcerative colitis due to infection with MAC. The patient recovered pr
omptly after administration of antimycobacterial therapy. MAC infection sho
uld be included in the differential diagnosis of gastrointestinal bleeding
in all immunodeficient patients. The significance of repeated colonoscopy t
o obtain multiple biopsy specimens with histological examination for foam c
ells and specific staining for acid-fast organisms is emphasized. (C) 1999
by Am. Coll. of Gastroenterology.