PMC5173512_01
Neck CT findings at day 28 of cART. a: Osteolytic invasion into the thyroid cartilage can be seen. b, c: Multiple cervical lymphadenopathy contains abscess lesions. d: Subcutaneous abscess can be seen in front of the manubrium sterni.
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On day 18, his temperature rose to 40 C and cervical lymph node (LN) swelling became more conspicuous with severe tenderness (Fig. 1).
Histological findings after a lymph node biopsy. a: Granuloma is seen (Hematoxylin and Eosin staining, 40x). b: Thin acid fast bacilli are detected (Ziehl-Neelsen stain, 1,000x).
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Histologically, non-caseous granuloma was seen (Fig. 2a), and relatively thin bacilli were detected in Ziehl-Neelsen staining (Fig. 2b).
Scotochromogenic colonies of the Mycobacterium shigaense sub-cultured on 2% Ogawa egg slant medium.
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Tokyo, Japan), it was scotochromogenic with an intense yellow color in both light and dark conditions (Fig. 3). Therefore, the strain was thought to belong to the Runyon II group.
Cutaneous lesions at day 31 of cART.
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A subcutaneous abscess with a protruding erythematous lesion appeared on the sternum and grew to 5 cm in diameter within a week (Fig. 4).
Clinical course. ABC: abacavir, ALP: alkaline phosphatase, CAM: clarithromycin, CRP: C-reactive protein, DRV/r: darunavir/ritonavir, EB: ethanbutol, INH: isoniazid, 3TC: lamivudine, RBT: rifabutin
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The serum ALP level normalized at 12 weeks, HIV-RNA turned to negative at 16 weeks, and the CD4 count recovered to over 100/muL at 27 weeks after the initiation of cART (Fig. 5).