PMC7399251_01
Abdominal CT Scan - multiple adenopathy, necrotic and coalescent, difusely distributed in the mesenterium and around the mesenteric vessels, the largest with 2 cm in diameter.
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The CT scan confirmed the presence of this multiple adenopathy, sometimes necrotic and coalescent, diffusely distributed in the mesenterium, the largest with 2 cm in diameter (Fig. 1).
Ganglia biopsy - alteration of the gaglia architecture, filled with histiocytes and numerous Ziehl-Neelsen+, PAS- microorganisms, compatible with an atypical mycobacteriosis. Ziehl-Nielsen and Fite. 40 x .
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The histopathological examination showed an alteration of the ganglia architecture, filled with histiocytes and numerous Ziehl-Neelsen+, PAS- microorganisms (Fig. 2), which was compatible with an atypical mycobacteriosis.
Duodenum sample - infiltration by histiocytes (CD68+, S100-, PAS-), filled with numerous mycobacteria. Ziehl Neelsen and FITE + . 60x.
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Histopathological examination of the duodenum mucosa showed infiltration by histiocytes (CD68+, S100-, PAS-), filled with numerous mycobacteria (Ziehl Neelsen and FITE+) (Fig. 3).
Abdominal CT scan - "Sandwich sign" - compression of the superior mesenteric vein by the mesenteric ganglia.
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After 4 months under the antimycobacterial treatment, the patient, although clinically stable and with no signs of immune reconstitution inflammatory syndrome (CD4 + T-cel count of 94/uL and HIV viral load of 0 copies/mL), showed imagiological deterioration of the adenopathy, with presence of the "sandwich sign" (Fig. 4), meaning the mesenteric ganglia compressing the superior mesenteric vein.
Abdominal CT Scan - thrombosis of the inferior mesenteric vena.
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Another abdominal CT scan was performed, presenting similar findings as the ones previously described and thrombosis of the inferior mesenteric vena (Fig. 5).