case_images: PMC6914957_01
case_images: Rectal mucosal with ulcerations.
case_images: CRIGM2019-8129597.001.jpg
case_images: PMC6914957_01_CRIGM2019-8129597.001.jpg
case_images: fig1
case_images: Patient was admitted and colonoscopy performed to further identify the cause of rectal bleeding revealed diffusely erythematous, congested, friable rectal mucosa with two superficial ulcers (Figure 1).
case_images: Rectal biopsy showing diffuse expansion of lamina propria with infiltration by lymphohistiocytic cells. (H and E, magnification x200).
case_images: CRIGM2019-8129597.002.jpg
case_images: PMC6914957_01_CRIGM2019-8129597.002.jpg
case_images: fig2
case_images: Pathology for rectal biopsy revealed AFB positive organism (Figures 2 and 3) and culture revealed growth of Mycobacterium avium-intracellulare (MAI) organisms.
case_images: Rectal biopsy: acid fast staining showing sheets of macrophages packed with bundles of acid-fast bacilli, characteristic of Mycobacterium avium intracellulare. (Acid fast stain, magnification x400).
case_images: CRIGM2019-8129597.003.jpg
case_images: PMC6914957_01_CRIGM2019-8129597.003.jpg
case_images: fig3
case_images: Pathology for rectal biopsy revealed AFB positive organism (Figures 2 and 3) and culture revealed growth of Mycobacterium avium-intracellulare (MAI) organisms.
case_images: Liver biopsy with nonnecrotizing granuloma. Composed of lymphohistiocytic collections. (H and E, magnification x400).
case_images: CRIGM2019-8129597.004.jpg
case_images: PMC6914957_01_CRIGM2019-8129597.004.jpg
case_images: fig4
case_images: Pathology was reported to have necrotizing granulomas composed of lymphohistiocytic collections (Figure 4), highly suggestive of MAI infection.
case_images: Friable rectal mucosa with edema (2 months after initiation of MAI treatment).
case_images: CRIGM2019-8129597.005.jpg
case_images: PMC6914957_01_CRIGM2019-8129597.005.jpg
case_images: fig5
case_images: Patient was on and off the recommended regimen, flexible sigmoidoscopy after a short course of interrupted treatment again demonstrated similar initial findings in the rectum (Figure 5) but a follow up colonoscopy 20 months after diagnosis showed healing of rectal mucosa with negative biopsies for MAC.