G Pavlos, C Antonios
cavitary, dialysis, mycobacterium avium
G Pavlos, C Antonios. Mycobacterium Avium Complex Associated Cavitary Lung Disease In A Long-Term Haemodialysis Patient. The Internet Journal of Nephrology. 2003 Volume 1 Number 2.
The compromised immunological state of dialysis patients has an effect of altering the immune response to almost every known pathogen when compared with the healthy population, giving atypical clinical findings. We report a rare case of a cavitary lung disease due to
The progressive deterioration of renal function is accompanied by a parallel decline in the immune status of the patient (1). Treatment by haemodialysis does not restore a normal immune response and sometimes may contribute to the suppression of the immune system (2). This is a clinically important situation because, even after controlling all modern parameters of adequacy of dialysis, infections remain one of the main causes of death in the haemodialysis population. Patients are anergic, highly susceptible to various infectious agents, and do not respond adequately to vaccinations especially with thymus-depended antigens. The abatement involves mainly the cell-mediated immune response. Clinically this is manifested by an enhanced susceptibility to mycobacterioses for which dialysis patients have a ten to fifteen times higher incidence than the healthy population (3,4).
Among the mycobacterioses diagnosed in our dialysis unit we describe a case of lung infection due to
There were still no findings in his blood tests although a slight increase in his epoetin dose was necessary to keep his haemoglobin close to 12mg/dl. Repeated Gram and
Four weeks later acid-fast colony types were isolated in Löwenstein-Jensen medium cultures. The isolates were identified as
The patient showed no response to treatment, deteriorated progressively and died following a cardiopulmonary arrest, during a haemodialysis session. The
In the case of
In our patient the disease presented with a typical manifestation with features similar to those of post-primary tuberculosis and radiological features indistinguishable from those of a cavitary tuberculosis disease (11). Pulmonary MAC infection has five distinct clinico-radiological manifestations: (a)
This patient's case is unique since for the first time a cavitary lung disease was associated with
Pavlos C. Goudas, 40 Panahaikou str, Patras 26224, GREECE Email: email@example.com Phone: +30 2610 322193