Mycobacterium avium Complex Osteomyelitis in Persons With Human Immunodeficiency Virus: Case Series and Literature Review

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.

Nontuberculous Mycobacterial Musculoskeletal Infection Cases from a Tertiary Referral Center, Colorado, USA

“…Previous case reports and series of NTM musculoskeletal infections have focused on the demographics, diagnosis, and treatment of patients with these difficult-to-manage infections (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Patients were often immunocompetent persons who contracted an NTM disease after direct inoculation via traumatic skin puncture (25)(26)(27)(28).…”

Coexistent Pseudogout andMycobacterium avium-intracellulareSeptic Arthritis in a Patient with HIV and ESRD

“…Synovial fluid findings are very similar to Mycobacterium tuberculosis arthritis. PCR is also considered to be of great reliability in diagnosing MAI [ 6 ]. Nevertheless, definitive diagnosis is established by histology and culture [ 3 ].…”

“…Nevertheless, definitive diagnosis is established by histology and culture [ 3 ]. The management of MAI septic arthritis is comprised of surgical debridement and antimycobacterial drugs [ 6 , 14 ]. Most regimens consist of macrolide and ethambutol, combined with fluoroquinolone or rifamycin.…”

“…Clinical history and physical examination, as well as basic lab work, raise suspicion; nevertheless, definitive diagnosis is established by the joint aspiration, biopsy, and microbiologic cultures. Polymerase chain reaction (PCR) is also considered as an adjuvant diagnostic modality [ 6 ]. Treatment in the majority of cases consists of surgical debridement and antimycobacterial drugs [ 6 ].…”

“…Polymerase chain reaction (PCR) is also considered as an adjuvant diagnostic modality [ 6 ]. Treatment in the majority of cases consists of surgical debridement and antimycobacterial drugs [ 6 ].…”