多發性肌炎合併瀰漫性Mycobacterium avium intracellulare complex 感染一病例及其他五例非愛滋病患者報告

Disseminated Mycobacterium avium intracellulare complex Infection in a Patient with Polymyositis and Review of Five Other Non-AIDS Cases

瀰漫性Mycobacterium avium intracellulare complex感染很少發生在非愛滋病人，本篇報告描述一位多發性肌炎患者合併瀰漫性Mycobacterium aviumintracellulare complex感染。本篇並且整理從1988到2003年其他五例，非愛滋病患者合併瀰漫性Mycobacterium avium intracel1ulare complex感染。常見的臨床表現有發燒，體重減輕，咳嗽，局部感染軟組織疼痛，肝脾腫大及淋巴結節腫大。常見侵犯的部位為肺部，骨頭，肋膜及淋巴結節。非愛滋病患者合併瀰漫性Mycobacterium avium intracellulare complex感染非常罕見，病人從發病到確立診斷常經較長的時間，且常誤以為是結核菌感染。因此，當免疫不全的病人有發燒，體重減輕，咳嗽，局部感染軟組織疼痛，淋巴結節腫大，骨頭侵犯，及肝脾腫大時，瀰漫性Mycobacterium avium intracellulare complex感染要列入鑑別診斷。

Disseminated mycobacterium avium intracellulare complex (MAC) infection is quite rare in non-AIDS patients. We report here a man with polymyositis, complicated with disseminated MAC infection. Five other non-AIDS cases suffered from disseminated MAC infection in our hospital from 1988 to 2003 were also analyzed. Constitutive symptoms and signs including fever, body weight loss, cough, local soft tissue pain, hepatosplenomegaly and lymphadenopathy were frequently observed. The involvement in lung, bone, pleura, and lymph nodes are rather common. The time to correct diagnosis is usually delayed and in mis-diagnosed as ordinary TB is common. When a patient had prolonged differential diagnosis of fever, productive cough, lymphadenopathy, bone involvement or hepatosplenomegaly, differential diagnosis of disseminated MAC infection should be included.