Infections by opportunistic non-tuberculous mycobacteria (NTM) are rising in global incidence. One emerging, slowly growing NTM is Mycobacterium haemophilum, which can cause skin, lung, bone, and soft tissue infections in immunocompromised patients as well as lymphadenitis in immunocompetent individuals. Detection of this microorganism is difficult using conventional culture-based methods and few reports have documented involvement of this pathogen within the central nervous system (CNS).We describe the neuropathologic autopsy findings of a 39-year-old man with AIDS who died secondary to M. haemophilum CNS infection. He initially presented with repeated bouts of pyrexia, nausea and vomiting, and altered mental status that required numerous hospitalizations. CSF infectious workups were consistently negative. His most recent admission identified hyperintensities within the brainstem by MRI and despite antibiotic therapies for suspected CNS infection, he died. Autopsy revealed a swollen brain with marked widening of the brainstem. Microscopic examination of the brain and spinal cord showed focal lymphohistiocytic infiltrates, gliosis and neuronal loss that were associated with acid-fast bacilli (AFB). The brainstem was the most severely damaged and AFB were found to congregate along arterial territories lending support to the notion of hematogenous spread as a mechanism for the organisms' dissemination. 16S rRNA sequencing on formalin-fixed paraffin-embedded tissue enabled post-mortem identification of M. haemophilum. This sequencing methodology may permit diagnosis on CSF intra-vitam.

中文翻译：

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在艾滋病中继发于嗜血分枝杆菌感染的脑膜脑脊髓炎。

机会性非结核分枝杆菌（NTM）感染在全球发病率中呈上升趋势。一种新兴的，生长缓慢的NTM是分枝杆菌嗜血杆菌，它可以在免疫功能低下的患者中引起皮肤，肺，骨和软组织感染，并在免疫能力强的患者中引起淋巴结炎。使用传统的基于培养的方法很难检测到这种微生物，并且很少有文献报道这种病原体参与中枢神经系统（CNS）。我们描述了一名39岁的艾滋病患者的神经病理尸检结果，该患者死于继发于M. haemophilum CNS感染。最初，他反复出现发热，恶心和呕吐，并且精神状态改变，需要多次住院治疗。脑脊液传染性检查一直为阴性。他最近的入院通过MRI确认了脑干内的高信号，尽管怀疑中枢神经系统感染有抗生素疗法，但他还是死了。尸检显示大脑肿胀，脑干明显变宽。大脑和脊髓的显微镜检查显示局灶性淋巴组织细胞浸润，神经胶质增生和神经元丢失，与抗酸杆菌（AFB）有关。脑干受损最严重，发现AFB沿动脉领土聚集，为血统传播的概念提供了支持，这是生物传播的机制。在福尔马林固定石蜡包埋的组织上进行16S rRNA测序，可对死后嗜血杆菌进行死后鉴定。这种测序方法可以允许对脑脊液中维生素进行诊断。