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Abstract
A patient who developed an atypical manifestation of Mycobacterium avium complex (MAC) infection almost two years after starting effective highly active antiretroviral therapy is described. The recurrence, manifested as brain abscesses in the central nervous system, was an uncommon form of MAC disease usually reported postmortem. An increased CD4 cell count, localized and suppurative infection, and the absence of systemic evidence of infection were consistent with a late immune reconstitution syndrome. The present case report adds to the understanding of MAC disease in HIV-infected patients.
Highlights
A patient who developed an atypical manifestation of Mycobacterium avium complex (MAC) infection almost two years after starting effective highly active antiretroviral therapy is described
We report the case of an HIV-1infected patient who developed an unusual and potentially devastating localized brain infection due to MAC almost two years after starting effective highly active antiretroviral therapy (HAART) and 17 months after attaining a sustained elevation of CD4 cell count over 150 cells/μL
The present case of central nervous system (CNS) MAC disease relapsing after sustained adequate immune recovery and virological control under HAART represents a rarely described syndrome, which is consistent with a diagnosis of MAC-immune reconstitution syndrome (IRS)
Summary
Cerebral Mycobacterium avium abscesses: Late immune reconstitution syndrome in an HIV-1-infected patient receiving highly active antiretroviral therapy. A patient who developed an atypical manifestation of Mycobacterium avium complex (MAC) infection almost two years after starting effective highly active antiretroviral therapy is described. Clinicians began to describe unusual clinical presentations of previously common OIs, which were identified or worsened during the first few weeks after the initiation of HAART These atypical presentations have since been recognized as inflammatory reactions directed at quiescent opportunistic pathogens following CD4 increases with HAART, otherwise known as the immune reconstitution syndrome (IRS) [2,3,4]. We report the case of an HIV-1infected patient who developed an unusual and potentially devastating localized brain infection due to MAC almost two years after starting effective HAART and 17 months after attaining a sustained elevation of CD4 cell count over 150 cells/μL. Due to a suboptimal virological response after six months with a viral load of 14,120 copies/mL, the regimen was changed to didanosine, efavirenz and lopinavir/ritonavir using
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