Mycobacterium avium duodenal infection mimicking Whipple's disease in a patient with AIDS.

intensive care unit for the management of septic shock secondary to infection with Salmonella enteritidis. The patient was also found to have Pneumocystis jiro− veci and Mycobacterium avium pneumo− nia. Further work−up revealed him to be HIV−positive, with a CD4 count of 125/ mm3. The patient was started on a treat− ment regimen of cefotaxim, trimetho− prim/sulfamethoxazole, prednisolone, clarithromycin, and ethambutol. He de− veloped severe malnutrition (body mass index 13.2 kg/m2, serum albumin 14 g/L) and was referred to our endoscopy center for placement of a percutaneous endo− scopic gastrostomy. Esophagogastroduodenoscopy revealed a whitish nodular pattern in the second part of the duodenum (l" Fig. 1) and biopsies were obtained from this region. Pathological examination of these no− dules showed extensive infiltration of the lamina propria with foamy histio− cytes (l" Fig. 2); tests were positive for periodic acid±Schiff reagent (l" Fig. 3) and acid−fast staining (with diffuse bacil− lary inclusions, as shown in l" Fig. 4) and negative for cytomegalovirus immuno− histochemistry. Duodenal biopsy cultures were positive for M. avium and a diagno− sis of M. avium gastrointestinal infection in a patient with recently diagnosed ad− vanced AIDS was made. Despite intensive care and specific treatment with clari− thromycin and ethambutol, the patient died of acute respiratory distress syn− drome. M. avium is the most common mycobac− terium implicated in infections of the gastrointestinal tract in AIDS. It usually causes fever, diarrhea, and weight loss. Possible duodenal endoscopic findings are: normal mucosa, erythema, whitish exudate, and nodules mimicking Whip− ple’s disease, this last appearance being the most distinctive feature [1 ±4]. Nota− bly, this Whipple−like appearance is not only an endoscopic feature but is also seen on microscopic examination on standard staining (but not on acid−fast staining). A similar endoscopic pattern has also been described in a patient with gastrointestinal Mycobacterium gena− vense infection complicating advanced AIDS [5].