Disseminated Mycobacterium colombiense Disease in a Person Living with HIV: Diagnostic and Therapeutic Considerations.

BACKGROUND

Disseminated non-tuberculous mycobacterial (NTM) disease is an uncommon but serious complication in people living with HIV. Rare species such as Mycobacterium colombiense are infrequently reported, and guidance on diagnosis and treatment remains limited. This case illustrates challenges in identifying and managing disseminated M. colombiense infection.

DESCRIPTION: A middle-aged man living with HIV presented with disseminated Talaromyces marneffei infection complicated by hemophagocytic lymphohistiocytosis. He received antifungal therapy, immunomodulatory treatment, and antiretroviral therapy. During immune recovery, he developed progressive hepatic lesions and systemic inflammation, followed by osteoarticular involvement. Conventional microbiological tests were repeatedly negative, while metagenomic next-generation sequencing of liver tissue identified Mycobacterium colombiense. The patient was treated with prolonged macrolide-based combination antimycobacterial therapy, alongside corticosteroids for immune reconstitution inflammatory syndrome. Due to focal bone involvement, surgical debridement was performed. Following combined medical and surgical management, clinical symptoms resolved, inflammatory markers improved, and imaging demonstrated regression of lesions.

CONCLUSION

Disseminated M. colombiense infection should be considered in people living with HIV who develop unexplained visceral or skeletal lesions during immune recovery. Early use of molecular diagnostic tools is critical when routine investigations are inconclusive. Prolonged individualized multidrug therapy, combined with selective surgical intervention for focal disease, may improve clinical outcomes in rare NTM infections.