Lung Pathology: Student/Resident Case Report Poster - Lung Pathology II |

A Case of Post-Obstructive Pneumonia Secondary to Mycobacterium Avium Complex Immune Reconstitution Inflammatory Syndrome in an HIV-Positive Patient FREE TO VIEW

Umair Tariq, MD; Marina Dolina, MD
Author and Funding Information

York Hospital, York, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):812A. doi:10.1016/j.chest.2016.08.908
Text Size: A A A
Published online

SESSION TITLE: Student/Resident Case Report Poster - Lung Pathology II

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Focal manifestation of mycobacterium avium complex (MAC) may occur in AIDS patients after initiation HAART therapy. Immune Reconstitution Inflammatory Syndrome (IRIS) can occur within three months of initiation of HAART therapy and can unmask MAC infections that have been present prior to the initiation of HAART. MAC associated IRIS manifests as fever, cough, night sweats, dyspnea, weight loss, hemoptysis and painful lymphadenitis that occurs four to eight weeks after HAART. Isolated pulmonary MAC infection is uncommon even though colonization in lungs is quite common and may be predictive of disseminated disease.

CASE PRESENTATION: A 34 year old HIV positive female who was recently started on HAART therapy after she was found to have pneumocystis pneumonia (PCP) presented to our institution with dyspnea due to non-resolving pneumonia. She had recent admission at an outside hospital for similar symptoms with a CT scan of thorax concerning for enlarged mediastinal lymph nodes and pneumonia. Bronchoscopy was positive for PCP and she completed standard treatment for PCP and noticed an improvment in her symptoms. A repeat CT of the thorax at our institution showed bilateral hilar and mediastinal adenopathy, and persistent pneumonia. A repeat bronchoscopy revealed multiple endobronchial masses with complete obstruction of segmental bronchus in lingula and partial obstruction of right upper and lower lobe bronchi. Pathology from needle biopsy returned positive for MAC and bacterial cultures were positive for MAC and klebsiella pneumonia (KP). She was treated for KP and discharged home on standard MAC therapy.

DISCUSSION: MAC infections often cause disseminated disease in AIDS patients. Report of isolated pulmonary MAC infection appeared in literature in 1988 after zidovudine became available. Symptoms in MAC infections due to IRIS generally begin to appear two to four weeks after HAART therapy initiation and treatment of isolated pulmonary MAC is generally successful. In the United States retrospective studies have reported IRIS in 31% of HIV infected patients and 20% of MAC-IRIS is fatal. It still remains one of the most difficult types of IRIS to manage.

CONCLUSIONS: Our patient had such an extensive lymphadenopathy with an invasion of the airway causing post-obstructive pneumonia. Isolated pulmonary MAC infections can be easily diagnosed, however the majority of patients with MAC-IRIS have negative blood and bone marrow cultures. Pathology and culture results from bronchial wash remains important for an accurate diagnosis and timely therapy initiation.

Reference #1: Carlos Salama (2016). Isolated pulmonary myocobacetrium avial complex infection in patients with HIV. Oxfordjournalsorg. Retrieved 1 April, 2016, fromhttp://cid.oxfordjournals.org/content/37/3/e35.full

Reference #2: Margaret M Johnson (2016). Nontuberculous myobacterial pulmonary infections. 210-220.PubMed Central (PMC). Retrieved 1 April, 2016, fromhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3949190/

DISCLOSURE: The following authors have nothing to disclose: Umair Tariq, Marina Dolina

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543