Capsule endoscopy in the diagnosis of disseminated Mycobacterium avium complex infection

Description

A 25-year-old man with HIV infection was admitted with generalised abdominal pain, fever and vomits. He had been diagnosed a few months earlier with disseminated Mycobacterium avium Complex (MAC) infection through a bone marrow biopsy but had abandoned all treatments. Blood tests showed pancytopenia with CD4 lymphocyte count of 0,034x10⁹/L (normal 0.41–1,59 x10⁹/L) and a raised alkaline phosphatase of 541 IU/L (normal 40–150 IU/L) with otherwise normal liver tests. Abdominal ultrasound and CT showed multiple coeliac and lateroaortic lymphadenopathies as well as a homogeneous hepatosplenomegaly; the oesophagogastroduodenoscopy (OGD) showed only a congestive bulbar mucosa. The patient was then referred for a capsule endoscopy: the small bowel mucosa was oedematous, with prominent lymphangiectasia and multiple ulcers, more exuberant proximally, that were suggestive of MAC infection (figure 1) (see video 1 in the online ). Distal duodenal biopsies showed a macrophage infiltration in the lamina propria (

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