Mycobacterium avium septicemia with ARDS in a patient with diabetes mellitus and no other known immune-compromising condition.

A 39-year-old diabetic male sustained 4 culture-proven episodes of disseminated Mycobacterium avium complex infection over a span of 6 years. The first, second, and fourth episodes were manifested clinically by osteomyelitis. The third episode was characterized by Mycobacterium avium complex septicemia (positive blood cultures for Mycobacterium avium complex) and acute respiratory failure with features of acute respiratory distress syndrome requiring mechanical ventilation and positive end-expiratory pressure for up to 30 days. Studies for impaired immunity including human immunodeficiency virus infection, idiopathic CD4+ T lymphocytopenia syndrome, and interferon deficiency were negative. Intensive treatment of the fourth episode with amikacin, clarithromycin, rifampin, isoniazide, ethambutol, and pyrazinamide for 2 months followed by 2 years of treatment with the same regimen without amikacin resulted in apparent cure. The patient has remained free of clinical infection for 13 years. The possible role of diabetes in pathogenesis is discussed.