Intestinal Mycobacterium avium complex infection: a rare case of small-bowel atrophy

We report the case of a 57-year-old woman with acquired immunodeficiency syndrome (AIDS) who was admitted to the emergency room with fever, diarrhea, and severe malnutrition (body mass index [BMI] 15.8 kg/m2). Her history was notable for human immunodeficiency virus (HIV) infection with poor therapeutic adherence, which had been complicated by multiple opportunistic infections. Esophagogastroduodenoscopy and colonoscopy were macroscopically normal. A video capsule endoscopy was performed, which revealed diffuse jejunal atrophy, and whitish and edematous enteric mucosa with scalloping ([Video 1]). Subsequently, anterograde double-balloon enteroscopy confirmed significant signs of atrophy with scalloping and a mosaic pattern in the jejunum ([Fig. 1]). Subsequent histologic examination raised the suspicion of Mycobacterium avium complex (MAC) ([Fig. 2]), which was confirmed afterward by polymerase chain reaction (PCR). Treatment was therefore initiated with rifabutin, azithromycin, and ethambutol with clinical improvement.