University of Illinois at Chicago Chicago, IL, United States
Rohit Agrawal, MBBS1, Jeffrey Rebhun, MD1, James Yang, MD1, Elie Ghoulam, MD, MS1, Sarang Thaker, MD, MS2, Constantine Melitas, MD1, Edward Villa, MD1 1University of Illinois at Chicago, Chicago, IL; 2University of Illinois at Chicago College of Medicine, Chicago, IL
Introduction: Mycobacterium celatum, a slow growing non-tubercular mycobacterium (NTM), causes localized infections in lungs and lymph nodes in both immunocompetent and compromised hosts. Here we report the first documented case of pancreatic abscess due to M. celatum.
Case Description/Methods: A 35-year-old female with history of HIV/AIDS with inconsistent adherence to anti-retroviral therapy (ART)presented with several months of epigastric pain and weight loss with anorexia. She was afebrile but hypotensive to 70/50 with heart rate of 133. Labs were notable for an absence of leukocytosis or leukopenia; lipase of 61 U/L; lactate of 2.3 mmol/L; and CD4 count of less than 35 CEL/UL. A Computed tomography (CT) of the abdomen and pelvis demonstrated dilatation of the common bile duct to 13 mm as well as a large, cystic or necrotic pancreatic mass measuring 64 mm by 25 mm by 45 mm (Figure 1A).
An Endoscopic Ultrasound (EUS) demonstrated multiple anechoic, septated cystic lesions in the pancreatic head, body, and tail with the largest measuring 60 mm by 44 mm in maximally cross-sectional diameter (Figure 1B). Blood-tinged, purulent fluid was aspirated, cultures grew M. celatum. She was restarted on azithromycin and levofloxacin along with her ART. She was discharge home in stable condition.
Discussion: M. celatum is contracted by inhalation or direct inoculation from environmental sources given its ubiquitous nature. It produces symptoms like other mycobacterial infections such as cough, weight loss and night sweats and most reported cases are of cavitary pulmonary lesions. Involvement of pancreas has not been reported;however this organism likely has the similar pathogenic mechanisms as other mycobacteria’s. In our patient, EUS was instrumental in confirmatory diagnosis by providing samples. Cultures are the most reliable tests asthese organisms cross-react with gene-probes used for M. tuberculosis making the diagnosis challenging. Standard therapy has not been established yet. Treatment regimens include combinations of azithromycin, clarithromycin, ciprofloxacin, ethambutol, rifabutin, and amikacin for long periods. These organisms should be suspected when acid-fast organisms do not respond to standard mycobacterial therapy.
Figure: Figure 1: A: Computed tomography of the abdomen and pelvis demonstrating dilatation of the common bile duct to 13 mm as well as a large, cystic or necrotic pancreatic mass measuring 64 mm by 25 mm by 45 mm; B: Endoscopic Ultrasound demonstrating multiple anechoic, septated cystic lesions in the pancreatic head, body, and tail with the largest measuring 60 mm by 44 mm.
Disclosures: Rohit Agrawal indicated no relevant financial relationships. Jeffrey Rebhun indicated no relevant financial relationships. James Yang indicated no relevant financial relationships. Elie Ghoulam indicated no relevant financial relationships. Sarang Thaker indicated no relevant financial relationships. Constantine Melitas indicated no relevant financial relationships. Edward Villa indicated no relevant financial relationships.
Rohit Agrawal, MBBS1, Jeffrey Rebhun, MD1, James Yang, MD1, Elie Ghoulam, MD, MS1, Sarang Thaker, MD, MS2, Constantine Melitas, MD1, Edward Villa, MD1. P1110 - Mycobacterium celatum: A New Pathogen of the Pancreas, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
