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Chronic pachymeningitis: Unusual manifestation of a Mycobacterium avium intracellulare complex infection in a nonimmunosuppressed patient

Chronic pachymeningitis: Unusual manifestation of a Mycobacterium avium intracellulare complex infection in a nonimmunosuppressed patient

Aktuelle Neurologie 23(2): 78-81

Extrapulmonary disease caused by atypical mycobacteria usually occurs in patients with deficient cellular immunity. We describe a 52-year old patient who suffered from a cerebral infection with these bacteria without the usual predisposing conditions. Cranial magnetic resonance imaging (MRI) showed bilateral dural thickening with diffuse contrast enhancement as a correlate of chronic headache. Cultures of chronic inflammatory cerebrospinal fluid were negative, but atypical mycobacteria of the Mycobacterium avium intracellulare complex (MAC) could be isolated from a meningeal biopsy. Clinical symptoms and MRI changes disappeared completely with a combination drug regimen. Infections with atypical mycobacteria have to be considered in the differential diagnosis of inflammatory dural diseases even in non-immunosuppressed patients. A correct microbiological diagnosis is essential for therapy, as multiple drug resistance requires a specific antibiotic combination treatment. A biopsy can be necessary to prove the pathogenicity of these ubiquitous organisms.

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