Disseminated Mycobacterium kansasii infection

A child with the sex-linked form of severe, combined immunodeficiency (SCID) presented with fever, cutaneous lesions and multiple foci of osteomyelitis. He was found to have disseminated mycobacteriosis due to Mycobacterium kansasii. His course was complicated by pancytopenia, pathologic fractures, and drug-induced hepatitis. Despite therapy with isoniazid, rifampin, ethambutol, and streptomycin, he succumbed to progressive cachexia and intercurrent Pneumocystis carinii pneumonia, since attempted immunologic reconstitution with fetal liver and thymus was unsuccessful. The clinical aspects of the patient's course and the postmortem findings are presented. The literature on disseminated M. kansasii infections is reviewed and its predilection for immunologically abnormal hosts is discussed.