AIDS. 1) Mycobacterium avium MRI (T2WI) HTLV-1 AIDS. Key words: Mycobacterium avium AIDS. Mycobacterium. complex MAC M. avium M.

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1 AIDS Mycobacterium avium 1) 2) 3) 4) 4) 3) 3) 3) 5) 1) 6) 1) 2) 3) 4) 5) 6) MRI (T2WI) MRI 5 Mycobacterium avium M. avium HIV HTLV-1 AIDS AIDS Key words: Mycobacterium avium AIDS Mycobacterium 75 5 / ) Mycobacterium avium complex MACM. avium M. intracellulare 70 2) ( ) TEL: FAX: kensabu@suwa.jrc.or.jp (AIDS) M. avium AIDS M. avium mm Vol. 18 No

2 CT MRI (T2WI) MRI 1A uptake 1 B Ga CT 1C CT 1D 1 Bence Jones Protein p-anca, c-anca still 1. A, MRI; B, C, CT, D, CT 32 Vol. 18 No

3 AIDS WBC 20,200 /ml TP 8.5 g/dl Neu 85.4 Alb 3.6 g/dl Lym 11.0 AST 22 IU/L Mon 2.3 ALT 24 IU/L Eos 0.9 LDH 222 IU/L Bas 0.4 ALP 330 IU/L RBC /ml BUN 10.0 mg/dl Hb 12.1 g/dl CRE 0.52 mg/dl Ht 38.8 Ca 10.1 mg/dl Plt /ml CRP 9.94 mg/dl CEA 1.9 ng/ml ng/ml RA 3.2 IU/ml SS-A/Ro CD SS-B/La CD SIL U/ml 2. CT HIV HTLV-1 Ziehl Neelsen CT 2 5 (L5) M. avium M. avium M. avium 300 mg/ 750 mg/ 1g mg/ mg/ 800 mg/ 8 4 MRI CRP L5 Ziehl Neelsen Vol. 18 No

4 PCR ( ) ( ) ( ) ( ) ( ) ( ) (1 ) M. avium M. avium ( ) M. avium M. avium L5 ( ) M. avium M. avium ( ) ( ) ( ) DNA PCR (1 ) PCR L5 M. avium PCR K DNA PCR M. avium 8 6 L5 7 PCR M. avium 1 -SR (S), (R), (S), (R), (S), (S), (R), (S), (R), (S) M. avium AIDS M. avium MAC MAC 3), 4) 4) M. avium 5) HIV HTLV mg mg 12 mg AIDS (IFN)g 6) IFNg 7) IFNg AIDS PCR M. avium PCR M. avium PCR Ziehl Neelsen Ziehl Neelsen 1,000 8) PCR DNA PCR M. avium PCR PCR 34 Vol. 18 No

5 AIDS 197 PCR BacT/Alert3D 9), 10) SA BacT/Alert3D 60 BacT/Alert 3D 11) Ziehl Neelsen PCR M. avium AIDS M. avium 90 5) PCR M. avium PCR MAC 44 1) David, E. G., T. Aksamit, B. A. Brown-Elliott, et al An o$cial ATS/IDSA statement: Diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am. J. Respir. Crit. Care Med. 175: ) : ) : ) PPD 65: ) Inderlifd, C. B., C. A. Kemper, L. M. Bermudez The Mycobacterium avium complex. Clin. Microbiol. Rev. 6: ) Tanaka, Y., T. Hori, K. Ito, et al Disseminated Mycobacterium avium complex infection in a patient with autoantibody to interferon-g. Internal Medicine 46: ) Ottenho#, T. H., F. A. Verreck, E. G. Lichtenauer-Kaligis, et al Genetics, cytokines and human infectious disease: lessons from weakly pathogenic mycobacteria and salmonellae. Nat. Genet. 32: ) : ) Hanscheid, T., C. Monterio, J. Melo Cristino, et al Growth of Mycobacterium tuberuculosis in conventional BacT/ALERT FA blood culture bottles allows reliable diagnosis of mycobacteremia. J. Microbiol. 43: ) Kasuga, E., T. Matsumoto, K. Oana, et al Evaluation of BacT/Alert 3D SA Bottles for accurate Detection of Mycobacteremia with special reference to Mycobacterium abscessus. Eur J Med Res. 12: ) D. 33: Vol. 18 No

6 198 A Case of Multiple Osteomyelitis Due to Mycobacterium avium in an Non-AIDS Patient Harumi Oguchi, 1) Toshio Sato, 2) Takefumi Suzuki, 3) Shinya Houkibara, 4) Masahiko Shimomura, 4) Eriko Kasuga, 3) Takehisa Matsumoto, 3) Eiko Hidaka, 3) Yoshiyuki Kawakami, 5) Kazuo Morozumi, 1) Tsutomu Hachiya 6) 1) Department of Laboratory Medicine, Suwa Red Cross Hospital 2) Department of Cardiology, Suwa Red Cross Hospital 3) Department of Laboratory Medicine, Shinshu University Hospital 4) Department of Pathology, Suwa Red Cross Hospital 5) Department of Biomedical Laboratory Sciences, School of Health Sciences, Shinshu University School of Medicine 6) Department of Respiratory, Suwa Red Cross Hospital Non-tuberculous mycobacteria are known to cause opportunistic infectious diseases in immunocompromised patients. We encountered a case of disseminated non-tuberuculous mycobacteriosis due to Mycobacterium avium. Patient was a 46 year-old woman who was transferred to our hospital because of conspicuously abnormal high-intensity area on lumbar vertebrae by means of MRI scanning examination. Her chief complaints were fever, cervical lymphadenopathy, and low back pain. She was evident of progressive cervical lymphadenopathy and myelitis, and therefore was suspected of a bone marrow disease, metastatic carcinoma, connective tissue diseases, and tuberculosis. Finally, she was diagnosed as multiple osteomyelitis by the successful detection of M. avium from her iliac bone marrow fluid and biopsy of right iliac bone and 5th lumbar vertebra. She was demonstrated to be negative in both HIV and HTLV- 1 antibody tests, and demonstrated to possess no indicative sign of immunodeficiency. She was treated in outpatient clinic with combined administration of three anti-tuberculous drugs comprising of ethambtol, kanamycin, rifampicin, together with clarithromycin. The extrapulmonary infection with M. avium has rarely been described. This was an infrequent case of disseminated M. avium infection, occurred in a non-aids female patient lacking in immunodeficiency. 36 Vol. 18 No