A RARE CASE OF DISSEMINATED MYCOBACTERIAL SEPTICEMIA (LANDOUZY SEPTICEMIA) IN AN HIV-NEGATIVE PATIENT

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Landouzy septicemia or disseminated mycobacterial is an uncommon diagnosis. Especially in immunocompetent individuals but one we must not forget. CASE PRESENTATION: 33-year-old Guatemalan woman, with no known history of disease presented headache, fever, chills, abdominal pain, weakness & shortness breath for the past two months. Physical examination(PE) was significant a temperature 39.4 C, heart rate 128 bpm blood pressure 96/55 mmHg. Ill-appearance, sounds were diminished bilaterally, rest PE unremarkable. At admission, CBC and renal function within normal limits, AST/ALT ALP elevated. A day after she developed acute encephalopathy, hypotension neck stiffness, Kernig Brudzinski signs. She septic shock, transferred to ICU mechanical ventilation, vasopressor support, broad-spectrum antibiotics. COVID PCR resulted negative. Lactate 12.6 mmol/L, AST: 549 ALT: 118 U/L. Cr: 1.7 BUN: 36. Bronchoalveolar lavage positive rifampin-sensitive Mycobacterium tuberculosis (MTB). Influenza via intranasal PCR. CT chest demonstrated bilateral reticulonodular interstitial infiltrates, suggesting atypical pneumonia, T11 vertebral body hypodense lesion. abdomen pelvis revealed nodular liver. Lumbar puncture showed opening 29cm H20, CSF studies hazy appearance, protein 594 mg/dL, glucose <20 elevated WBC, negative Toxoplasma, CMV, VDRL, VZV, HIV, HSV-1, enterovirus, cryptococcus, JC virus, MTB. MRI thoracolumbar spine T11-T12 osteomyelitis, leptomeningeal epidural enhancement. An echocardiogram diffuse LV hypokinesis EF 20%. HIV negative, though had absolute CD4 count 48 cel/mcL. Immunoglobulins limits. Repeated cultures during hospitalization. We started RIPE therapy dexamethasone. The patient's mentation did recover, off sedation. Subsequently, brain ischemic infarction subcortical region hemorrhagic transformation, MRV head notable cortical venous thrombosis. Despite adequate treatment AFB identification, expired 11 days into her DISCUSSION: patient rare presentation common disease. ultimately succumbed landouzy septicemia. manifestation resulting multiorgan failure carries high mortality, usually seen immunocompromised patients, unlike our case. CD4+ lymphocytopenia associated influenza infection might have unmasked latent CONCLUSIONS: severe It should be differential even given mortality. REFERENCE #1: Floyd K, Glaziou P, Zumla A, Raviglione M. global epidemic progress care, prevention, research: overview year 3 End TB era. Lancet Respiratory Medicine. 2018;6(4):299-314. #2: Hagan G, Nathani N. Clinical review: Tuberculosis on intensive care unit. Care. 2013;17(5):240. #3: Nichols JE, Niles JA, Roberts NJ. Human Lymphocyte Apoptosis Exposure Virus. Journal Virology. 2001;75(13):5921-9. DISCLOSURES: No relevant relationships by Baher AL Abbasi, source=Web Response Carlos Dorta, Adam Friedlander, Katherine Hodgin, Christopher Siriphand, Vergara-Sanchez,