Mycobacterium avium–intracellulare brain abscesses in an HIV-infected patient

Abstract

The Mycobacterium avium–intracellulare complex (MAC) is an uncommon cause of brain abscesses even in patients with acquired immunodeficiency syndrome (AIDS). We present a case of a multiple MAC brain abscesses, confirmed by brain biopsy and culture, in a patient with AIDS. The patient's initial symptoms were weakness, confusion and headaches. The patient was initially treated for toxoplasmosis and pyogenic bacterial brain abscesses with no resolution. Following treatment for MAC the patient's abscesses resolved.

Difficulty in diagnosing intracranial infection caused by Mycobacterium avium in an AIDS patient: case report and review of the literature

“…In our case, repeated blood cultures were negative, and the positive results of brain tissue culture took a long time. Several cases of AIDS patients with brain lesions due to M. avium infection had reported negative cultures of blood [ 13 , 19 ], which may be caused by the low level of the bacterial load. We speculated the reason for the low level of the bacterial load, which may be impacted by immune function in HIV patients.…”

Mycobacterium Avium Complex Infection as a Rare Cause of Cerebral Mass Lesion and IRIS in a Patient with AIDS: Case Report and Review of the Literature

“…More than half of patients were diagnosed with a MAC brain abscess in the absence of known pulmonary or disseminated MAC infection ( Table 1 ). Eleven cases occurred in patients with HIV [ 5–12 , 22 ]. In these cases, CD4+ T-cell count ranged from 2 to 210 cells/µL (median, 31 cells/µL), and only 2 patients had an undetectable viral load at the time that the brain abscess was identified [ 4 ].…”

“…The majority of patients experienced headache and other nonspecific neurologic complaints, including dizziness, nausea/vomiting, altered mental status, and gait instability. Five patients experienced seizures, and specific neurologic deficits were described depending on the location of the abscesses, including focal weakness, expressive aphasia, ataxia, and diplopia [ 5 , 16 ]. In contrast to pyogenic abscess, fever was described in only 1 case report [ 12 ].…”

“…Similar approaches have been considered for CNS tuberculosis [ 29 ]. Fluoroquinolones (ciprofloxacin, moxifloxacin) [ 5 , 10 , 11 , 14 , 16 , 19 ] and aminoglycosides (amikacin and kanamycin) [ 7 , 10 , 15 , 16 ] have also been employed in other reported cases of MAC brain abscesses. In the cases that provide details of the treatment course, antibiotics were provided for 6 to 24 months, and the majority of patients experienced clinical and radiographic improvement with these regimens ( Table 1 ).…”