LETTER
Central Nervous System Infection with Mycobacterium kansasii
Gary A. Bergen;
Bienvenido G. Yangco; and
Harold A. Adelman
1 March 1993 | Volume 118 Issue 5 | Page 396
TO THE EDITOR:
Atypical mycobacterial infections occur in at least 50% of patients with the acquired immunodeficiency syndrome (AIDS). We present the first reported case of a central nervous system (CNS) tuberculoma and meningitis caused by disseminated Mycobacterium kansasii.
A 42-year-old homosexual white man with AIDS presented with frontal headaches for 2 weeks; confusion and intermittent fever for 1 week; and loss of balance and falling for 1 day. The patient was receiving zidovudine, 600 mg/d. Past medical history included Kaposi sarcoma and Pneumocystis carinii pneumonia.
Physical examination showed thrush, bilateral cervical adenopathy, and Kaposi sarcoma on the chest and back. The blood leukocyte count was 2600 x 109/L with 40% lymphocytes. The absolute CD4 count was 92 x 109/L. Cerebrospinal fluid protein was 690 mg/L, the cerebrospinal fluid leukocyte count was 0 cells/mL, and glucose was normal. Cerebrospinal fluid stains and antigens were negative. Empiric antimicrobials were started while cultures incubated. The purified protein derivative test and control were negative. The chest roentgenogram was normal.
A computed tomography (CT) scan of the head showed a 4-cm enhancing mass in the right occipitoparietal region. Aspiration of the lesion yielded pus. Smears of sputum, blood, and abscess showed acid-fast bacilli. Polymerase chain reaction of abscess aspirate was positive for M. kansasii and weakly positive for M. intracellulare. Blood, sputum, and cerebrospinal cultures grew M. kansasii. The patient improved during treatment with isoniazid, rifampin, and ethambutol, and after 1 month of therapy, blood cultures were negative for acid-fast bacilli. A computed tomography scan showed resolution of the lesion after 3 months. The patient remained stable for 6 months, until his death from complications of pulmonary Kaposi sarcoma. No autopsy was done.
Central nervous system involvement by nontuberculous mycobacteria occurs rarely [1, 2]. To our knowledge, this is the first case of disseminated M. kansasii with a central nervous system tuberculoma in a patient with AIDS. Most M. kansasii infections have been described in immunosuppressed hosts, and they commonly involve the lungs. Dissemination and extrapulmonary involvement may occur via the blood or lymphatic system [3-5]. The treatment for M. kansasii is effective and similar to that for M. tuberculosis, chiefly, isoniazid, rifampin, and ethambutol [5].
1. Bishburg E, Sunderam G, Reichman LB, Kapila R. Central nervous system tuberculosis with the acquired immunodeficiency syndrome and its related complex. Ann Intern Med. 1986; 105:210-3.
2. Gordon SM, Blumberg HM.Mycobacterium kansasii brain abscess in a patient with AIDS (Letter). Clinical Infectious Diseases. 1992; 14: 789-90.
3. Woodring JH, Vandiviere HM. Pulmonary disease caused by nontuberculous mycobacteria. J Thorac Imaging. 1990; 5:64-76.
4. Horsburgh CR Jr, Selik RM. The epidemiology of disseminated nontuberculous mycobacterial infection in the acquired immunodeficiency syndrome (AIDS). Am Rev Respir Dis. 1989; 139:4-7.[Medline]
5. Francis PB, Jay SJ, Johanson WG Jr. The course of untreated Mycobacterium kansasii disease. Am Rev Respir Dis. 1975; 111:477-87.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Top
References
Article
