Case Report

Localized Mycobacterium avium Complex Infection of Vertebral and Paravertebral Structures in an HIV Patient on Highly Active Antiretroviral Therapy

Authors: Vicente Corrales-Medina, MD, Stephen Symes, MD, Martin Valdivia-Arenas, MD, Catherine Boulanger, MD

Abstract

Before the introduction of highly active antiretroviral therapy (HAART)Mycobacterium avium complex (MAC) disease was the most common bacterial infection in patients with acquired immune deficiency syndrome (AIDS) in developed countries.1 Effective antiviral therapy against HIV has allowed for control of viral replication, improvement in immune function, and a significant decrease in opportunistic infections (OIs).2 However, atypical presentations of these infections have been increasingly described in patients a few weeks after the initiation of HAART. This clinical worsening despite decrease in HIV viral load and increase in CD4+ lymphocyte cell count is called immune reconstitution syndrome (IRS).3 We report a case of localized vertebral and paravertebral MAC infection in an HIV-infected patient with high CD4+ lymphocyte counts, more than one year after starting antiretroviral therapy.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Jones JL, Hanson DL, Chu SY, et al. Surveillance of AIDS defining conditions in the United States.AIDS 1994;8:1489–1493.
 
2. Kapkan JE, Hanson D, Dworkin MS, et al. Epidemiology of Human Immunodeficiency Virus-Associated Opportunistic Infections in the United States in the Era of Highly Active Antiretroviral Therapy. Clin Infect Dis 2000;30:S5–14.
 
3. Shelburne SA III, Hamill RJ. The immune reconstitution inflammatory syndrome. AIDS Rev2003;5:67–79.
 
4. Cabie A, Abel S, Brebion A, et al. Mycobacterial lymphadenitis after initiation of highly active antiretroviral therapy. Eur J Clin Microbiol Infect Dis 1998;17:812–813.
 
5. Boyd AE, Brettle RP. Mycobacterium avium intracellulare psoas abscess in patients with AIDS after antiretroviral therapy. AIDS 1999;13:2185–2186.
 
6. Aberg JA, Chin-Hong PV, McCutchan A, et al. Localized osteomyelitis due to Mycobacterium avium complex in patients with human immunodeficiency virus receiving highly active antiretroviral therapy. Clin Infect Dis 2002;35:e8–13.
 
7. Nalaboff KM, Rozenshtein A, Kaplan MH. Imaging of Mycobacterium avium-intracellulare infection in AIDS patients on highly active antiretroviral therapy: Reversal syndrome. AJR 2000;175:387–390.
 
8. Erard P, Robert-Grandpierre F, Kaeser P. Vertebral osteomyelitis caused by Mycobacterium avium intracellulare in a patient with AIDS. Clin Microbiol Infect 1999;5:643–644.
 
9. Currier JS, Williams PL, Koletar SL, et al., for the AIDS Clinical Trials Group 362 Study Team: Discontinuation of Mycobacterium avium complex prophylaxis in patients with antiretroviral therapy-induced increases in CD4+ cell count. Ann Intern Med 2000;133:493–503.
 
10. Aberg JA, Williams PL, Liu T, et al. A study of discontinuing maintenance therapy in human immunodeficiency virus-infected subjects with disseminated Mycobacterium avium complex: AIDS Clinical Trial Group 393 Study Team. J Infect Dis 2003;187:1046–1052.
 
11. Narita M, Ashkin D, Hollender ES, et al. Paradoxical worsening of tuberculosis following antiretroviral therapy in patients with AIDS. Am J Respir Crit Care Med 1998;158:157–161.
 
12. French MA, Lenzo N, John M. Immune restoration disease after the treatment of immunodeficient HIV-infected patients with highly active antiretroviral therapy. HIV Medicine 2000;1:107–115.
 
13. Michelet C, Arvieux C, Francois C, et al. Opportunistic infections occurring during highly active antiretroviral treatment. AIDS 1998;12:1815–1822.
 
14. Hassell M, French MA. Mycobacterium avium infection and immune restoration disease after highly active antiretroviral therapy in a patient with HIV and normal CD4+ counts. Eur J Clin Microbiol Infect Dis 2001;20:889–891.
 
15. DeSimone JA, Pomerantz RJ, Babinchak TJ. Inflammatory reactions in HIV-1 infected persons after initiation of highly active antiretroviral therapy. Ann Intern Med 2000;133:447–454.