AEGiS-14IAC: Central nervous system Mycobacterium tuberculosis and Mycobacterium avium complex infection in an HIV-positive patient.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Central nervous system Mycobacterium tuberculosis and Mycobacterium avium complex infection in an HIV-positive patient.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. A10056)

Fletcher VP, Schliep T, Schicchi J, Sadr WE
Division of Infectious Diseases, Harlem Hospital Center, New York, United States

ISSUES: Central nervous system (CNS) ring-enhancing lesions in patients with acquired immunodeficiency syndrome (AIDS) may be caused by a number of pathogens including Toxoplasma gondi and Mycobacterium tuberculosis (MTB). Mycobacterium avium complex (MAC) is an uncommon cause of CNS lesions, and to our knowledge, the isolation of MTB and MAC from the same CNS ring-enhancing lesion has not been reported before.

DESCRIPTION: A Mexican woman with AIDS, CD4 cell count of 140 cells/mm³, who presented with fever, headaches and night sweats was found to have multiple CNS ring-enhancing lesions on magnetic resonance imaging. A single photon emission computed tomography scan showed multiple areas of increased uptake, suggestive of CNS lymphoma. A contrast enhanced computed tomography of the chest showed diffuse nodular interstitial densities. She had no clinical or radiological improvement with therapy for toxoplasmosis and underwent a stereotactic brain biopsy. Brain tissue histopathology showed changes consistent with an abscess wall containing numerous free and intracellular acid-fast bacilli without granuloma formation. Mycobacterial culture of the brain tissue grew both MAC and MTB. Histopathology of a transbronchial biopsy specimen showed no granulomas, and mycobacterial stain and culture were negative. Polymerase chain reaction for MTB and MAC done on the lung tissue was also negative. Blood cultures for mycobacteria were negative.

LESSONS LEARNED: This is the first report of MAC and MTB infection occurring concurrently in a cerebral abscess in a patient with AIDS. Dual mycobacterial infections in the same cerebral mass lesion are rare occurrences even in severely immunosuppressed patients.

RECOMMENDATIONS: Stereotactic brain biopsy remains the diagnostic procedure of choice in AIDS patients with ring-enhancing brain lesions that fail to respond to empiric treatment for toxoplasmosis.

Keywords: AEGIS, Mycobacterium avium Complex, Mycobacterium, Tuberculosis, Central Nervous System, AIDS Dementia Complex, HIV Seropositivity, Acquired Immunodeficiency Syndrome, Mycobacterium avium-intracellulare Infection, Toxoplasmosis, Mycobacterium tuberculosis, CD4 Lymphocyte Count, Tuberculosis, Mycobacterium Infections, Mycobacterium Infections, Atypical, Toxoplasma, Tomography, Emission-Computed, Single-Photon, Brain Diseases, Brain, Human, Female, Animal, radionuclide imaging

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A10056