Abstract Details

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Abstract Details

Title Mycobacteria avium complex (MAC) Brain Abscess in an AIDS Patient: Case Report and Literature Review

Topic Infectious Disease

Presentation(s) P12 - Poster Session 12 (12:00 PM-1:00 PM)

Poster/Presentation
Number 13-012

Objective

Describe the clinical, neuropathological and microbiological features of MAC brain abscess in an AIDS patient.

Background Systemic MAC infection in AIDS is common, however, central nervous system involvement is exceptionally rare

Design/Methods Case report and literature review.

Results A 45-year-old man with a history of AIDS, presently with CD4+ 108 and VL 2,720, MAC on sputum culture, and herpes zoster ophthalmicus, presented with confusion and hallucinations. MRI showed four parietal and temporal ring enhancing lesions (maximum size 0.8 cm). He was empirically started on anti-toxoplasmosis and anti-tuberculosis and anti-MAC therapy and over two weeks, he had progression of peri-lesional edema and hallucinations and therefore a brain biopsy was performed. Tissue sections showed multiple nodular granulomata with lymphoplasmacytoid cells, epithelioid histiocytes and rare giant cells. No caseous necrosis is seen but foci of micronecrosis are present. No toxoplasmosis or primary CNS lymphoma was present. Very abundant acid-fast bacilli were seen on Fite and auramine stains. Immunohistochemistry demonstrated abundant CD8⁺ T cell infiltration suggestive of IRIS. Cultures where not performed, however, mycobacterial PCR demonstrated MAC sequences (University of Washington and confirmed at Mayo Laboratories). He was treated with high dose steroids (dexamethasone 8mg Q 8 hours) which was subsequently tapered, RHZE (rifampin 35mg/ kg, isoniazid, pyrazinamide, ethambutol) plus clarithromycin 500 mg BID that was switched to azithromycin 500 mg to decrease QTc prolongation. He was continued on ART and at last clinic visit approximately 5 months after diagnosis of CNS MAC, he was alert and functional.

Conclusions Brain MAC abscess is very rare with less than 10 cases being previously reported in both AIDS and non-AIDS patients. This diagnosis should be considered in immunocompromised patients who do not respond to anti-toxoplasmosis therapy as brain biopsy can provide actionable therapeutic information.

Authors/Disclosures
J. Clay Goodman, MD, F�鶹��ýӳ�� PRESENTER	Dr. Goodman has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for American Board of Psychiatry and Neurology (ABPN). The institution of an immediate family member of Dr. Goodman has received research support from NIH.
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