Mesotherapy-associated Outbreak Caused by Mycobacterium immunogenum

CSF was negative for 16S bacterial RNA by PCR and culture-negative for H. infl uenzae, and the CSF pleocytosis had decreased substantially. These circumstances make it less likely that these signs were associated with the underlying H. infl uenzae disease and raise the possibility that superimposed HAdV-40 infection played a role. Because the patient had no diarrhea or respiratory symptoms, no evidence of immunodefi ciency, no stool specimen available for testing, and no evidence of HAdV in throat swab specimen, the pathogenesis of HAdV-40 infection in this case is unknown. The origin of the maculopapular rash concurrent with neurologic symptoms in this patient is also unclear. Rash is not typical for H. infl uenzae infection and, although reported for some HAdV infections (7), has not been previously described for HAdV-40/41. In conclusion, this case demonstrates the possibility of nongastroenteric, systemic infection involving CNS with enteric HAdV in immunocompetent hosts. Broad-specifi city AdV PCR assay followed by amplicon sequencing enabled detection of this pathogen in an unexpected context and can be useful in defi ning the nongastroenteric disease effects associated with the enteric HAdVs.