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Mycobacterium avium Complex Osteomyelitis in Persons With Human Immunodeficiency Virus: Case Series and Literature Review.

Wood BR, Buitrago MO, Patel S, Hachey DH, Haneuse S, Harrington RD - Open Forum Infect Dis (2015)

Bottom Line: In persons with advanced immunosuppression, Mycobacterium avium complex (MAC) typically causes disseminated disease with systemic symptoms.We summarize 17 additional cases of HIV-associated MAC osteomyelitis from the literature and compare CD4 count at presentation for vertebral cases versus nonvertebral cases, which reveals a significantly higher CD4 at presentation for vertebral cases (median 251 cells/µL vs 50 cells/µL; P = .043; Mann-Whitney U test).Among HIV-infected individuals with osteomyelitis, MAC should be considered a possible etiology, particularly in the setting of immune reconstitution.

View Article: PubMed Central - PubMed

Affiliation: Division of Allergy and Infectious Diseases , University of Washington , Seattle.

ABSTRACT
In persons with advanced immunosuppression, Mycobacterium avium complex (MAC) typically causes disseminated disease with systemic symptoms. We report 2 cases in which MAC caused localized osteomyelitis in human immunodeficiency virus (HIV)-infected individuals on antiretroviral therapy with rising CD4 counts. We summarize 17 additional cases of HIV-associated MAC osteomyelitis from the literature and compare CD4 count at presentation for vertebral cases versus nonvertebral cases, which reveals a significantly higher CD4 at presentation for vertebral cases (median 251 cells/µL vs 50 cells/µL; P = .043; Mann-Whitney U test). The literature review demonstrates that the majority of cases of MAC osteomyelitis, especially vertebral, occurs in individuals with CD4 counts that have increased to above 100 cells/µL on antiretroviral therapy. Among HIV-infected individuals with osteomyelitis, MAC should be considered a possible etiology, particularly in the setting of immune reconstitution.

No MeSH data available.


Related in: MedlinePlus

Sagittal views of the lumbar spine reveal a heterogeneous mass demonstrating decreased T1 (A) and increased T2 signal (B and D) involving the L1 and L2 lumbar body and disc. The mass reveals peripheral enhancement in postcontrast T1 flair images (C).
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OFV090F1: Sagittal views of the lumbar spine reveal a heterogeneous mass demonstrating decreased T1 (A) and increased T2 signal (B and D) involving the L1 and L2 lumbar body and disc. The mass reveals peripheral enhancement in postcontrast T1 flair images (C).

Mentions: A 50-year-old man, who had been diagnosed with HIV in 2007 with a CD4 nadir of 14 cells/µL and had never taken ART, was found to have stage 1 large B-cell non-Hodgkin's lymphoma of the esophagus in August 2010. He received 1 cycle of R-EPOCH chemotherapy. His CD4 count before chemotherapy was 20 cells/µL. He also started ART in August 2010 and initially struggled with adherence but had confirmed suppression of HIV RNA by April 2011 and HIV RNA remained routinely suppressed thereafter. Computed tomography (CT) scans of the chest, abdomen, and pelvis performed in January, March, and July 2011 for cancer surveillance showed no pathologic lesions of the spine. In January 2012, at which time his CD4 count had increased to 414 cells/µL, he presented to care for back pain. Magnetic resonance imaging (MRI) demonstrated decreased T1 signal and increased T2 signal in L1 and L2 with an enhancing 4.3 × 4 cm mass involving the inferior L1 and superior L2 vertebral bodies (Figure 1). He reported no systemic symptoms. Prophylactic azithromycin had been stopped more than 2 years prior.Figure 1.


Mycobacterium avium Complex Osteomyelitis in Persons With Human Immunodeficiency Virus: Case Series and Literature Review.

Wood BR, Buitrago MO, Patel S, Hachey DH, Haneuse S, Harrington RD - Open Forum Infect Dis (2015)

Sagittal views of the lumbar spine reveal a heterogeneous mass demonstrating decreased T1 (A) and increased T2 signal (B and D) involving the L1 and L2 lumbar body and disc. The mass reveals peripheral enhancement in postcontrast T1 flair images (C).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499669&req=5

OFV090F1: Sagittal views of the lumbar spine reveal a heterogeneous mass demonstrating decreased T1 (A) and increased T2 signal (B and D) involving the L1 and L2 lumbar body and disc. The mass reveals peripheral enhancement in postcontrast T1 flair images (C).
Mentions: A 50-year-old man, who had been diagnosed with HIV in 2007 with a CD4 nadir of 14 cells/µL and had never taken ART, was found to have stage 1 large B-cell non-Hodgkin's lymphoma of the esophagus in August 2010. He received 1 cycle of R-EPOCH chemotherapy. His CD4 count before chemotherapy was 20 cells/µL. He also started ART in August 2010 and initially struggled with adherence but had confirmed suppression of HIV RNA by April 2011 and HIV RNA remained routinely suppressed thereafter. Computed tomography (CT) scans of the chest, abdomen, and pelvis performed in January, March, and July 2011 for cancer surveillance showed no pathologic lesions of the spine. In January 2012, at which time his CD4 count had increased to 414 cells/µL, he presented to care for back pain. Magnetic resonance imaging (MRI) demonstrated decreased T1 signal and increased T2 signal in L1 and L2 with an enhancing 4.3 × 4 cm mass involving the inferior L1 and superior L2 vertebral bodies (Figure 1). He reported no systemic symptoms. Prophylactic azithromycin had been stopped more than 2 years prior.Figure 1.

Bottom Line: In persons with advanced immunosuppression, Mycobacterium avium complex (MAC) typically causes disseminated disease with systemic symptoms.We summarize 17 additional cases of HIV-associated MAC osteomyelitis from the literature and compare CD4 count at presentation for vertebral cases versus nonvertebral cases, which reveals a significantly higher CD4 at presentation for vertebral cases (median 251 cells/µL vs 50 cells/µL; P = .043; Mann-Whitney U test).Among HIV-infected individuals with osteomyelitis, MAC should be considered a possible etiology, particularly in the setting of immune reconstitution.

View Article: PubMed Central - PubMed

Affiliation: Division of Allergy and Infectious Diseases , University of Washington , Seattle.

ABSTRACT
In persons with advanced immunosuppression, Mycobacterium avium complex (MAC) typically causes disseminated disease with systemic symptoms. We report 2 cases in which MAC caused localized osteomyelitis in human immunodeficiency virus (HIV)-infected individuals on antiretroviral therapy with rising CD4 counts. We summarize 17 additional cases of HIV-associated MAC osteomyelitis from the literature and compare CD4 count at presentation for vertebral cases versus nonvertebral cases, which reveals a significantly higher CD4 at presentation for vertebral cases (median 251 cells/µL vs 50 cells/µL; P = .043; Mann-Whitney U test). The literature review demonstrates that the majority of cases of MAC osteomyelitis, especially vertebral, occurs in individuals with CD4 counts that have increased to above 100 cells/µL on antiretroviral therapy. Among HIV-infected individuals with osteomyelitis, MAC should be considered a possible etiology, particularly in the setting of immune reconstitution.

No MeSH data available.


Related in: MedlinePlus