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Enteric infection by Mycobacterium avium
Infección entérica por Mycobacterium avium
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Fluoroscopy and endoscopy view of a completed malignant gastric outlet obstruction (A and B). Ascites and a collapsed small bowel close to the gastric wall is EUS-guided punctured using a 22G needle (safer and better penetrability for accessing into the enteral lumen), filling contrast and saline into the target small bowel (C). Fluoroscopy confirmation (D). Once enteral lumen gains enough diameter, a second EUS-guided puncture with 19G needle (offering faster flow of liquid) is performed (E). Fluoroscopy confirmation of the successful gastroenterostomy, after direct “free-hand” method using an electrocautery-enhanced lumen-apposing metal stent (HotAxios;15<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mm).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Joan B. 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"apellidos" => "Gornals" ] 1 => array:2 [ "nombre" => "Dani" "apellidos" => "Luna-Rodriguez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382424000889?idApp=UINPBA00004N" "url" => "/24443824/0000004700000006/v2_202409200854/S2444382424000889/v2_202409200854/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image of the month</span>" "titulo" => "Enteric infection by <span class="elsevierStyleItalic">Mycobacterium avium</span>" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "625" "paginaFinal" => "626" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Laura Andrés Pascual, Sara García Morán, Gadea Hontoria Bautista, Teresa Lista Araujo, Cristina Labayru Echeverría, Manuel Alfonso Jiménez Moreno, Luis Buzón Martín" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Laura" "apellidos" => "Andrés Pascual" "email" => array:1 [ 0 => "laura.4cn50910@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Sara" "apellidos" => "García Morán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Gadea" "apellidos" => "Hontoria Bautista" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Teresa" "apellidos" => "Lista Araujo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Cristina" "apellidos" => "Labayru Echeverría" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Manuel Alfonso" "apellidos" => "Jiménez Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "Luis" "apellidos" => "Buzón Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital Universitario de Burgos, Burgos, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Santos Reyes, Aranda de Duero, Burgos, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infección entérica por <span class="elsevierStyleItalic">Mycobacterium avium</span>" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1444 "Ancho" => 1642 "Tamanyo" => 263404 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Gastroscopy. Multiple yellowish-white oval plaques in the second part of the duodenum.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">This was a 55-year-old man with stage C3 HIV infection and disseminated <span class="elsevierStyleItalic">Mycobacterium avium</span> infection, admitted for constitutional syndrome. He had severe acute anaemia with no external bleeding. Gastroscopy and colonoscopy were ordered.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the gastroscopy, from the second part of the duodenum until the length of the endoscope was exhausted, multiple yellowish-white oval plaques were observed on the mucosa, simulating Whipple's disease (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Colonoscopy revealed multiple small erythematous plaques surrounded by normal-appearing mucosa, with involvement of the entire colon (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Ileoscopy was normal. Biopsies from the duodenum and colon were sent for histology and microbiology. The histology of both locations showed expansion of the lamina propria by histiocytes loaded with abundant Ziehl-Neelsen-positive acid-fast bacilli, confirming enterocolitis infection by <span class="elsevierStyleItalic">Mycobacterium</span> (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Intestinal tissue smear microscopy was positive; <span class="elsevierStyleItalic">Mycobacterium avium</span> was isolated in the culture.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">It is unusual for <span class="elsevierStyleItalic">Mycobacterium avium</span> to affect the intestines.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We present this case with simultaneous upper and lower gastrointestinal tract involvement and different endoscopic imaging. Despite there being no characteristic endoscopic pattern, the most common form of presentation is that described previously in gastroscopy,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and awareness of this is important in order to suspect it and make an appropriate differential diagnosis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1444 "Ancho" => 1642 "Tamanyo" => 263404 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Gastroscopy. Multiple yellowish-white oval plaques in the second part of the duodenum.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1395 "Ancho" => 1642 "Tamanyo" => 198253 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Colonoscopy. Multiple small erythematous plaques surrounded by normal-appearing mucosa.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2446 "Ancho" => 1640 "Tamanyo" => 682044 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Duodenal mucosa (H&E on the left and Ziehl-Neelsen on the right, ×4) with expansion, over the lamina propria, of an infiltrate of histiocytes loaded with abundant Ziehl-Neelsen-positive acid-fast bacilli.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A rare case of disseminated Mycobacterium avium complex with colitis in a renal transplant recipient" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. 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