after five days.
The patient was discharged home with symptomatic treatment for his as- cites. He was restarted on combination antiretroviral therapy and scheduled for close follow-up with his infectious diseases primary care provider. Two weeks after discharge, cultures of the shoulder aspirate grew Mycobacte - rium kansasii (see Figures D, E). The speciation of the mycobacteria was first determined by high-performance liquid chromatography, which gave the isolate a similarity index of 0.887 for Mycobacterium kansasii and 0.573 for Mycobacterium szulgai (see Figure F). The isolate was later confirmed as My - cobacterium kansasii with a DNA probe for RNA target (GEN-PROBE). Blood cultures were consistently negative for acid-fast bacilli, indicating that his infection was likely not disseminated. Due to marked serum transami- nase elevations, thought to be hepatic disease, the patient was not able to receive treatment for his mycobacterial infection. His combination antiretro- viral therapy was halted as well. The patient expired approximately three months later due to progressively worsening liver failure. INTRODUCTION Mycobacterium kansasii is an atypi- cal, slow-growing mycobacterium that causes pulmonary infections in the immunocompromised host. It is the second-most common opportu- nistic atypical mycobacterial pathogen after Mycobacterium Avium Complex (MAC). 3 M. kansasii is commonly dif- ferentiated by its characteristic yellow pigmentation. It has been isolated almost exclusively from municipal water sources, and the majority of reported cases have presented in the southern United States. 1 M. kansasii is not considered a public-health threat, as there is no evidence of person-to- person transmission. The primary method of colonization is thought to be pulmonary. Pulmonary-disease presentation is similar to that of Mycobacterium tuberculosis , though symptoms are typically milder. 2 Pulmonary M. kansasii occurs in both
Figure A: Gross anterior image of chest and bilateral shoulders. The degree of anterior and lateral swelling of the right shoulder can be appreciated in comparison to the patient’s left shoulder.
Figure B: Anterolateral view of the patient’s right shoulder, status post-removal of fluid sample from bursa.
J La State Med Soc VOL 166 July/August 2014 183
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