Enteroenteric fistula of the duodenum in a patient with AIDS and Mycobacterium avium-intracellulare infection.

Upper gastrointestinal endoscopy revealed a double lumen in the second portion of the duodenum in a 39-year-old man with advanced acquired immunodeficiency syndrome (AIDS). The lesion was not lined with an epithelium and improved with antituberculous therapy. These findings, as well as both an extensive transmural inflammation with foamy macrophages laden with acid-fast microorganisms and the destruction of the bowel wall, were consistent with Mycobacterium avium-intracellulare infection, but not with congenital duplication. An upper gastrointestinal series was falsely negative. Deep, penetrating lesions and double-barreled lumen are not infrequent in AIDS-related esophageal disease. We propose that similar lesions related to M avium-intracellulare occur in the bowel, especially when immune impairment and mycobacterial infection are severe. Awareness of mycobacterial infections of the gut is important in the era of AIDS.