Disseminated Mycobacterium avium-Intracellulare Complex Infection Presenting With Disseminated Intravascular Coagulation in an AIDS Patient.

Folusakin Ayoade,Andrew Stevenson Joel Chandranesan,James Cotelingam

doi:10.1177/2324709617740904

Abstract

Disseminated Mycobacterium avium-intracellulare complex (MAC) infection is one of the relatively common opportunistic infections seen in severely immunocompromised AIDS patients. A constellation of clinical, laboratory, and pathological features involving multiple organ systems are often present in disseminated MAC infection but disseminated intravascular coagulation (DIC) has not been previously described in association with this condition. To our knowledge, this is the first reported case of DIC complicating disseminated MAC infection in an AIDS patient. In this article, we present the case of a 33-year-old AIDS patient with high viral load, CD4 lymphocyte count of 1/mm3, who presented with nonspecific symptoms, anemia, thrombocytopenia, and increased lactate dehydrogenase, alkaline phosphatase, and ferritin. She also had abnormal coagulation parameters and features compatible with chronic DIC. Bone marrow biopsy assisted in making the correct diagnosis. She also later grew MAC from blood and sputum cultures. There were no other factors identified after a complete workup to explain DIC in this patient. After commencement of appropriate MAC therapy, she initially had a good response with some improvement of her coagulation parameters. Few months later, however, probably attributable to poor medication compliance, her condition deteriorated with development of thromboembolism, full-fledged DIC, sepsis, and an eventual fatal outcome. This case illustrates the importance of including disseminated MAC in the differential diagnosis of DIC in an AIDS patient.

Highlights

Disseminated Mycobacterium avium-intracellulare complex (MAC) infection is a relatively common complication seen in advanced HIV, especially when the CD4 lymphocyte count falls below 50 cells/mm in the absence of appropriate prophylaxis
Even though her platelet counts initially improved, it later plummeted down again to as low as 14/μL with worsening of her coagulation parameters. Four weeks after her pulmonary embolism diagnosis, she developed sepsis and worsening Disseminated intravascular coagulation (DIC) and subsequently succumbed to her infection. This case illustrates an unusual presentation of disseminated MAC infection
The abnormal coagulation parameters, elevated D-dimer, thrombocytopenia, microangiopathic changes on peripheral blood smear, and venous thromboembolism are more consistent with DIC

Summary

Introduction

Disseminated Mycobacterium avium-intracellulare complex (MAC) infection is a relatively common complication seen in advanced HIV, especially when the CD4 lymphocyte count falls below 50 cells/mm in the absence of appropriate prophylaxis. Journal of Investigative Medicine High Impact Case Reports weight loss, progressive weakness, subjective fevers, and a witnessed seizure activity Her HIV viral load was 989 155 copies/mL and CD4 count was 1/mm[3]. Paracentesis was done, with analysis of ascitic fluid showing a transudate and culture negative for fungal and mycobacterial growth. Given her profound cytopenia, bone marrow biopsy was obtained. Even though her platelet counts initially improved, it later plummeted down again to as low as 14/μL with worsening of her coagulation parameters Four weeks after her pulmonary embolism diagnosis, she developed sepsis and worsening DIC and subsequently succumbed to her infection

Discussion

Ethics Approval