Dr Victoria Sasongko1, Dr Evan Browne1, Dr Clarence Ratnakumar1, Dr William James1
1Northern NSW LHD, LISMORE, Australia
Biography:
Bio to come
Background:
Mycobacterium Avium Complex (MAC) is a gram-positive acid-fast bacillus that is ubiquitous in the environment. It adheres to mucosal epithelial cells and infects macrophages where it typically lodges in the lymph nodes and disseminate elsewhere. Immunocompromised patients with MAC infection often present in non-specific ways, with recurrent fever and pulmonary disease being a common presentation.
Case Report:
A 49-year-old female with failing renal transplant after twenty-three years presented with incidental finding of a pulmonary nodule. Her biopsy confirmed Mycobacterium Avium Complex infection and she was commenced on triple therapy of Rifabutin, Ethambutol and Azithromycin. Over the course of the next few months, she was intermittently febrile with arthralgia, weight loss and developed right upper quadrant pain. Intravenous Ceftriaxone was added into her treatment regime. Ten months into her treatment course, she developed deep pelvic pain with drenching night sweats. Her Positron Emission Tomography-scan revealed a new dermoid-like right sided ovarian mass. Her Ca-125 was mildly elevated at 66 units/ml (upper limit of normal 25 units/ml). She proceeded to a laparoscopic oophorectomy with histology confirming granulomatous salphingitis.
Conclusion:
MAC infection can present in different ways after a protracted course of treatment, including masquerading as an ovarian mass – an unusual presentation. Cautious consideration should be given in the work-up of masses in an immunosuppressed patient with chronic granulomatous disease.