Document 0846
 DOCN  M9650846
 TI    The endoscopic appearance of severe intestinal Mycobacterium avium
       complex infection as a coarsely granular mucosa due to massive
       infiltration and expansion of intestinal villi without mucosal
       exudation.
 DT    9605
 AU    Cappell MS; Philogene C; Department of Medicine, Maimonides Medical
       Center, Brooklyn, New; York 11219, USA.
 SO    J Clin Gastroenterol. 1995 Dec;21(4):323-6. Unique Identifier : AIDSLINE
       MED/96159682
 AB    Although Mycobacterium avium complex (MAC) is the most common
       opportunistic pathogen at postmortem in patients with AIDS, many cases
       are not recognized premortem. A patient with advanced AIDS had diarrhea,
       fecal occult blood, and iron deficiency anemia.
       Esophagogastroduodenoscopy showed an extensive coarsely granular mucosa,
       resistant to endoscopic irrigation and brushing, in the descending
       duodenum. Histologic analysis of duodenal biopsies confirmed expansion
       of intestinal villi due to massive villar infiltration by acid-fast
       bacilli and no mucosal exudation. An absence of mucosal exudation is
       consistent with an attenuated local immunologic response in advanced
       AIDS. MAC was isolated from mycobacterial culture of duodenal biopsies.
       The currently reported endoscopic appearance of intestinal MAC can aid
       in diagnosis by alerting the endoscopist to send biopsies for
       mycobacterial stains and cultures when MAC infection is suggested by
       this endoscopic appearance. However, even in the absence of
       endoscopically evident lesions, gastrointestinal endoscopic biopsy is
       appropriate to exclude occult opportunistic pathogens in an AIDS patient
       with wasting or significant gastrointestinal complaints. The currently
       reported pathologic findings show that villar engorgement and
       hypertrophy is a sufficient explanation for the granular endoscopic
       appearance of intestinal MAC and that mucosal exudation is not required
       to produce this appearance.
 DE    Adult  AIDS-Related Opportunistic Infections/MICROBIOLOGY/*PATHOLOGY
       Biopsy  Case Report  Duodenal Diseases/*MICROBIOLOGY/*PATHOLOGY
       Endoscopy, Digestive System  Human  HIV
       Enteropathy/MICROBIOLOGY/*PATHOLOGY  Intestinal
       Mucosa/MICROBIOLOGY/*PATHOLOGY  Male  Mycobacterium avium-intracellulare
       Infection/COMPLICATIONS/  *PATHOLOGY  JOURNAL ARTICLE

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