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Mycobacterium avium complex pleuritis accompanied by diabetes mellitus
1Department of Internal Medicine, Public Tomioka General Hospital, Tomioka, Gunma, Japan.
Diabetes Research and Clinical Practice
|May 10, 2000
Summary
A rare case of pleuritis caused by Mycobacterium avium complex in a patient with diabetic nephropathy is presented. Prompt chemotherapy led to the resolution of pleural effusion, highlighting the importance of early diagnosis and treatment.
Area of Science:
- Infectious Diseases
- Nephrology
- Pulmonology
Background:
- Diabetic nephropathy is a common complication of diabetes mellitus.
- Mycobacterium avium complex (MAC) is an opportunistic pathogen that can cause disseminated disease in immunocompromised individuals.
Observation:
- A 72-year-old woman with diabetic nephropathy presented with peripheral edema and weight gain, followed by subfebrile temperature and diminished breathing in the left lower lung field.
- Chest X-ray revealed exudative pleural effusion; cultures and tuberculin tests were negative.
Findings:
- Polymerase chain reaction (PCR) detected Mycobacterium avium complex in pleural fluid, confirming a rare case of MAC pleuritis.
- The patient's pleural effusion resolved after 18 days of chemotherapy.
- Despite controlled hemoglobin A1c (HbA1c), her diabetic nephropathy worsened, with elevated urinary albumin and serum creatinine, and persistently low serum albumin.
Implications:
- This case suggests that malnutrition, impaired immunity, and microvascular complications associated with diabetes mellitus may predispose patients to opportunistic infections like MAC pleuritis.
- Early diagnosis using molecular methods like PCR is crucial for effective treatment of rare infections.