Correspondence

Mycobacterium avium Complex Inclusions Mimicking Gaucher's Cells

N Engl J Med 1999; 340:1372April 29, 1999

Article

To the Editor:

A 37-year-old man with insulin-dependent diabetes mellitus complicated by end-stage renal disease who had received a second cadaveric kidney transplant four years earlier presented with symptomatic splenomegaly, progressive anemia, prolonged fever, dysphagia, and weight loss. Owing to chronic rejection of his kidney transplant, he required intensive immunosuppressive therapy consisting of tacrolimus, mycophenolate mofetil, and prednisone. The first kidney transplant, as well as a pancreatic transplant, had been lost because of acute rejection, seven and three years previously, respectively.

Abdominal computed tomography performed on admission revealed splenomegaly with a subcapsular hematoma. Analysis of a bone marrow aspirate revealed numerous large histiocytes with striated cytoplasm (onionskin appearance), resembling Gaucher's cells (Figure 1AFigure 1Histologic Analysis of a Bone Marrow Aspirate (Panel A) and Bone Marrow–Biopsy Specimen (Panel B).). In Gaucher's disease, the inclusions result from the accumulation of phagocytosed glucocerebroside. However, acid-fast staining of a bone marrow–biopsy specimen showed that the histiocytic inclusions were actually innumerable acid-fast bacilli (Figure 1B). Polymerase-chain-reaction analysis of bone marrow identified the microorganism as Mycobacterium avium complex. Despite appropriate antibiotic therapy with azithromycin and ethambutol, respiratory, renal, and liver failure developed, and the patient ultimately died of profound lactic acidosis and septic shock due to disseminated M. avium complex infection.

Athanassios Argiris, M.D.
Noel Maun, M.D.
Nancy Berliner, M.D.
Yale University School of Medicine, New Haven, CT 06520

Citing Articles (2)

Citing Articles

1. 1

   Chih-wei Wang, Thomas V. Colby. (2007) Histiocytic lesions and proliferations in the lung. Seminars in Diagnostic Pathology 24:3, 162-182
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2. 2

   K. Doucette, J. A. Fishman. (2004) Nontuberculous Mycobacterial Infection in Hematopoietic Stem Cell and Solid Organ Transplant Recipients. Clinical Infectious Diseases 38:10, 1428-1439
   CrossRef