Laparoscopic Mesenteric Lymph Node Biopsy in the Diagnosis of Mycobacterium avium Complex

Abstract

Infection with the acid-fast bacilli Mycobacterium avium and Mycobacterium intracellulare, collectively referred to as the Mycobacterium avium complex (MAC) is a substantial diagnostic and clinical problem in children with human immunodeficiency virus (HIV) infection. Because blood cultures in patients with M. avium infection (MAI) are frequently negative, tissue biopsy and culture are often required to confirm the diagnosis or rule out malignancy. The use of laparoscopic mesenteric lymph node biopsy in three children presenting with clinical symptoms and radiographic findings (abdominal lymphadenopathy) consistent with MAC infection is described here. Three ports were utilized and positioned dependent upon CT findings. Adequate specimens for diagnosis were obtained without morbidity in all three children. This experience supports the use of laparoscopy as the preferred method of confirming intra-abdominal MAC infection in HIV infected children.