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• W1996053691 abstract "Mycobacterium xenopi, a nontuberculous mycobacterium, is uncommon in the United States (1Yates M.D. Grand J.M. Collins C.H. The nature of mycobacterial disease in southeast England, 1977-84.J Epidemiol Community Health. 1986; 40: 295-300Crossref PubMed Scopus (39) Google Scholar). It is found almost exclusively in water sources, especially hot-water systems (2Wallace Jr, R.D. O’Brien R. Glassroth J. Diagnosis and treatment of disease caused by nontuberculous mycobacterium.Am Rev Respir Dis. 1990; 142: 940-953Crossref PubMed Scopus (395) Google Scholar). Infected persons typically present with isolated pulmonary disease and rarely with any extrapulmonary manifestations (3Paley M. Sidhu P.S. Evans R.A. Karani J.B. Retroperitoneal collections—aetiology and radiological implications.Clin Radiol. 1997; 52: 290-294Abstract Full Text PDF PubMed Scopus (49) Google Scholar). We describe an immunocompromised patient who developed a psoas muscle abscess due to M. xenopi infection that was treated successfully with antimycobacterial drugs. A 60-year-old man with a history of acquired immunodeficiency syndrome (AIDS) was admitted for a painful mass over the left iliac crest that had been enlarging over 1 month. Trauma to that region had occurred 2 months before. No other symptoms, such as fever, weight loss, night sweats, or back pain, were reported. He was taking stavudine, lamivudine, indinavir, and aerosolized pentamidine. The physical examination revealed a temperature of 36.8oC, a pulse of 70 beats per minute, blood pressure of 115/85 mm Hg, a respiratory rate of 16 breaths per minute, and an oxygen saturation of 97% on room air. There was a fluctuant mass above the left iliac crest, measuring 10 cm by 11 cm with an erythematous central area (Figure 1 ). Pain was accentuated with flexion of his left hip. Laboratory findings included a white blood cell count of 11,600/mm3, with 67% neutrophils, 22% lymphocytes, and 10% monocytes. The absolute CD4 cell count was 180 cells/μL, and the viral load was <50 copies/mL. Blood cultures yielded no growth. A computed tomographic scan of the abdomen revealed a large (10 cm × 2.7 cm × 11 cm) loculated fluid collection involving the left iliocostalis lumborum muscle and a smaller (5.2 cm × 4.3 cm) fluid collection involving the left psoas muscle (Figure 2 ). Pus from the iliocostalis lumborum muscle revealed acid-fast bacilli, and a presumptive diagnosis of “cold abscess” due to Mycobacterium tuberculosis was made. The patient began treatment with isoniazid, rifabutin, pyrazinamide, and ethambutol pending final identification of the organism. Three months later, M. xenopi was cultured from the psoas aspirate. In vitro testing showed resistance to ethambutol, amikacin, and minocycline, but susceptibility to isoniazid, rifabutin, sulfamethoxazole, ciprofloxacin, and clarithromycin. The patient was then treated with isoniazid (300 mg once a day), rifabutin (150 mg once a day), clarithromycin (500 mg twice a day), ciprofloxacin (500 mg twice a day), and ethambutol (1200 mg once a day) for 18 months. His condition improved markedly, and he was well at 2-year follow-up. Psoas abscess due to M. xenopi infection is rare. There has been one other report in the literature (4Prigogine T. Stoffels G. Fauville-Dufaux M. et al.Primary psoas muscle abscess due to Mycobacterium xenopi.Clin Infect Dis. 1998; 26: 221-222Crossref PubMed Scopus (13) Google Scholar), which involved treatment of a patient with isoniazid, rifampin, ethambutol, and ciprofloxacin for 18 months. Our patient’s abscess was presumably due to hematogenous spread from a potential inoculation through trauma of his left iliac crest. Infection with M. xenopi is most common in immunocompromised patients, especially those with AIDS, owing to depression of cell-mediated immunity (5Bamberger D.M. Driks M.R. Gupta M.R. Mycobacterium kansasii among patients infected with human immunodeficiency virus in Kansas City.J Infect Dis. 1994; 18: 295-400Google Scholar). M. xenopi is uncommon in the United States, whereas in England it is the most common cause of nontuberculous mycobacterial pulmonary disease. The organism has also been reported to cause disseminated disease and joint disease (2Wallace Jr, R.D. O’Brien R. Glassroth J. Diagnosis and treatment of disease caused by nontuberculous mycobacterium.Am Rev Respir Dis. 1990; 142: 940-953Crossref PubMed Scopus (395) Google Scholar). No definitive therapeutic regimen has been defined for M. xenopi infection. In vitro susceptibility tests often have a poor correlation with clinical response. Despite the organism’s resistance to isoniazid, rifampin, pyrazinamide, and ethambutol, these agents are often the recommended first-line treatment (4Prigogine T. Stoffels G. Fauville-Dufaux M. et al.Primary psoas muscle abscess due to Mycobacterium xenopi.Clin Infect Dis. 1998; 26: 221-222Crossref PubMed Scopus (13) Google Scholar). Fluoroquinolones and macrolides have also been suggested as initial therapy (2Wallace Jr, R.D. O’Brien R. Glassroth J. Diagnosis and treatment of disease caused by nontuberculous mycobacterium.Am Rev Respir Dis. 1990; 142: 940-953Crossref PubMed Scopus (395) Google Scholar). Nontuberculous mycobacterial infections are more common, and present more often in extrapulmonary locations, in immunocompromised patients (6Lupatkin H. Brau N. Flomenberg P. Simberkoff M.S. Tuberculous abscesses in patients with AIDS.Clin Infect Dis. 1991; 14: 1040-1044Crossref Scopus (81) Google Scholar). Nontuberculous causes of an extrapulmonary abscess should be considered in patients with AIDS who present with a “cold abscess.”" @default.
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• W1996053691 title "Psoas abscess due to MYCOBACTERIUM XENOPI infection" @default.
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