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EDITOR’S QUIZ: GI SNAPSHOT

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From question on page 1430

Colonoscopy showed ulcerated polypoid lesions vulnerable to contact bleeding that appeared from the transverse colon up to the terminal ileum. Histological examination was remarkable for accumulation of macrophages containing acid fast bacilli consistent with an infection of non-tuberculous mycobacteria (NTM). Mycobacterial cultures revealed growth of Mycobacterium genavense (MG). MG is a newly recognised NTM that is found mainly in patients with acquired immunodeficiency syndrome and regularly affects the digestive tract. Intestinal infections due to NTM are known to mimic Whipple’s disease endoscopically and histologically. Ulcerative lesions affecting the large bowel and causing gastrointestinal bleeding represent a rare endoscopic finding.

Mycobacterial infections are uncommon complications in patients with hyper-IgE syndrome and treatment experiences are limited for this NTM species. Treatment was begun with a multidrug regimen of rifabutin, ethambutol, clarithromycin, and ciproflocazin. Three month follow up revealed regression of duodenal defects and normal mucosa on colonoscopy, indicating, to date, an adequate response to therapy.

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