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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 demonstrate a heterogeneous mass with diffuse signal alterations in the L1 vertebra extending into L2 and in L3 extending into L4 with enhancement of the vertebral bodies (A). Repeat images again reveal destruction of L1–L4 with small epidural fluid collection communicating between superior aspect of L3 through inferior aspect of L4 and extending into right L3–L4 neural foramen (B–D).
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OFV090F2: Sagittal views of the lumbar spine demonstrate a heterogeneous mass with diffuse signal alterations in the L1 vertebra extending into L2 and in L3 extending into L4 with enhancement of the vertebral bodies (A). Repeat images again reveal destruction of L1–L4 with small epidural fluid collection communicating between superior aspect of L3 through inferior aspect of L4 and extending into right L3–L4 neural foramen (B–D).

Mentions: A 52-year-old man was diagnosed with HIV in 2011 with baseline CD4 count of 40 cells/µL. He started ART and 5 months later was instructed to stop prophylactic azithromycin because his CD4 count had remained >100 cells/µL for 3 months. Nine months into ART, his CD4 count had increased to 250 cells/µL, but he developed severe axial low back pain. Plain radiographs indicated only mild lumbar disc degeneration. He returned 3 months later with increased pain. MRI demonstrated changes at L1–L2 and L3–L4, thought to be Schmorl's nodes. Despite conservative therapy, his pain persisted. He did not have any constitutional symptoms. Repeat imaging 4 months after the initial MRI showed what appeared to be increased size of the L1 Schmorl's node extending into L2, destruction of the posterior left lateral aspect of L1, and possible Schmorl's node extending from L3 into L4 (Figure 2). Due to concern for potential opportunistic infection, he underwent CT-guided biopsy of the L1 and L3 vertebral bodies; histopathology revealed changes consistent with chronic osteomyelitis, but cultures for bacteria, fungi, and mycobacteria remained negative.Figure 2.


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 demonstrate a heterogeneous mass with diffuse signal alterations in the L1 vertebra extending into L2 and in L3 extending into L4 with enhancement of the vertebral bodies (A). Repeat images again reveal destruction of L1–L4 with small epidural fluid collection communicating between superior aspect of L3 through inferior aspect of L4 and extending into right L3–L4 neural foramen (B–D).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

OFV090F2: Sagittal views of the lumbar spine demonstrate a heterogeneous mass with diffuse signal alterations in the L1 vertebra extending into L2 and in L3 extending into L4 with enhancement of the vertebral bodies (A). Repeat images again reveal destruction of L1–L4 with small epidural fluid collection communicating between superior aspect of L3 through inferior aspect of L4 and extending into right L3–L4 neural foramen (B–D).
Mentions: A 52-year-old man was diagnosed with HIV in 2011 with baseline CD4 count of 40 cells/µL. He started ART and 5 months later was instructed to stop prophylactic azithromycin because his CD4 count had remained >100 cells/µL for 3 months. Nine months into ART, his CD4 count had increased to 250 cells/µL, but he developed severe axial low back pain. Plain radiographs indicated only mild lumbar disc degeneration. He returned 3 months later with increased pain. MRI demonstrated changes at L1–L2 and L3–L4, thought to be Schmorl's nodes. Despite conservative therapy, his pain persisted. He did not have any constitutional symptoms. Repeat imaging 4 months after the initial MRI showed what appeared to be increased size of the L1 Schmorl's node extending into L2, destruction of the posterior left lateral aspect of L1, and possible Schmorl's node extending from L3 into L4 (Figure 2). Due to concern for potential opportunistic infection, he underwent CT-guided biopsy of the L1 and L3 vertebral bodies; histopathology revealed changes consistent with chronic osteomyelitis, but cultures for bacteria, fungi, and mycobacteria remained negative.Figure 2.

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