J Korean Rheum Assoc.  2009 Jun;16(2):150-155. 10.4078/jkra.2009.16.2.150.

A Case of Nontuberculous Mycobacteria Infection That Was Misdiagnosed as an Invasion of Wegener's Granulomatosis

• Ha DC
• Yoon J
• Cho SW
• Jeong JI
• Kim JY
• Kim HG
• Eom DW
• Kim SS

• KMID: 2202131
• DOI: http://doi.org/10.4078/jkra.2009.16.2.150

Abstract

Wegener's granulomatosis is a rare disease that pathologically causes necrotizing granulomatous vasculitis in the arterioles and venules and it can invade the whole body. In addition, it is difficult to distinguish between a nontuberculous mycobacteria infection that shows manifestations of granuloma and Wegener's granulomatosis. There has been no reported on a patient who had the 2 abovementioned two diseases at the same time. A 69 year old male patient had Wegener's granulomatosis that had invaded the prostate. He also had a scrotal swelling and back pain. He had manifestations of granulomatous infection on the scrotum and spine biopsies. However, there was no clinical evidence of Wegener's granulomatosis. As a result, we examined him for other diseases that can cause a granuloma. Consequently, he was also diagnosed as suffering with a nontuberculous mycobacteria infection. We report here on this case and we review the relevant medical literature.

Keyword

Wegener's granulomatosis; Nontuberculous mycobacteria infection

MeSH Terms

Arterioles
Back Pain
Biopsy
Granuloma
Humans
Male
Nontuberculous Mycobacteria
Prostate
Rare Diseases
Scrotum
Spine
Stress, Psychological
Vasculitis
Venules
Wegener Granulomatosis

Figure

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  Fig. 1. (A) The prostate shows a geographically necrotizing granulomatous inflammation. (B) A vasculitis is noted in the small to medium sized vessel. There are many inflammatory cells in the vessel wall and perivascular area (arrow). Fibrinoid necrotic material is noted in the vascular lumen (H&E stain, A ×100, B ×200).

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  Fig. 2. The scrotum reveals a necrotic granulomatous inflammation (A ×100, B ×200, H&E stain).

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  Fig. 3. (A) An acid fast bacillus (arrow) is noted on the Ziehl-Neelsen stain (A ×1,000), (B) Polymerase chain reaction analysis for NTM. The sample is equal to the result of the positive control (M: mark, P: positive control, S: sample).

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  Fig. 4. Magnetic resonance imaging of the lumbar. (A) An axial image reveals posterior epidural cystic lesion L4 body level with significant dural sac compression. (B) A sagittal image reveals inflammatory or infectious involvement, more likely than tumorous condition.

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  Fig. 5. The spine shows a granulomatous inflammation with necrosis (A ×100, B ×200, H&E stain).

Reference

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