Nemechek PM, Cimoch PJ, Reisman BK; Interscience Conference on Antimicrobial Agents and Chemotherapy.
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 1994 Oct 4-7; 197.
Center for Special Immunology, Irvine, CA.
Disseminated MAC is one of the most common serious complications of late stage AIDS. We report two cases of MAC sinusitis in AIDS patients receiving antiretrovirals and multiple pathogen prophylaxis including rifabutin 300 mg/day. A 32 y/o white male with AIDS (CD4=10) and multiple complications developed clear rhinorrhea, nonproductive cough and hectic fever. CT scan revealed chronic bilateral maxillary sinusitis with air-fluid levels in the left maxillary sinus. Blood cultures eventually grew MAC. The pt was tx with IV antibiotics, nasal steroids, mucolytics & decongestants for 6 weeks without improvement. Repeat CT scan showed pansinusitis with complete opacification. Antral sinus lavage exhibited suppurative inflammation with numerous AFB+ organisms identified as MAC by culture and DNA probe. Amikacin, clarithromycin, ethambutol & rifabutin were instituted with clinical improvement. The pt expired 3 weeks later. A 41 y/o white male with AIDS (CD4=12) and multiple complications developed purulent rhinorrhea, nonproductive cough and fever. Right sphenoid and bilateral maxillary sinusitis with air-fluid levels were noted on cranial MRI. Histopathology from an endoscopic biopsy showed chronic inflammation with stains negative for fungi, AFB, protozoa and CMV. Bacterial cultures were negative. AFB cultures were not done. The pt was treated with IV antibiotics, nasal steroids, mucolytics and decongestants for 8 weeks without resolution. The pt underwent functional endoscopic sinus surgery (FESS) for fevers and persistent sinusitis by MRI. Histopathology was again negative but sinus cultures were positive for MAC. Blood cultures for AFB were negative. Amikacin, clarithromycin, ethambutol & rifabutin were started. Repeat FESS was required for debridement and drainage. The pt became afebrile and improved symptomatically. These are the first reported cases of MAC sinusitis associated with AIDS. MAC sinusitis may respond to anti-MAC therapy and FESS. MAC infection of the sinuses should be considered in AIDS patients with refractory sinusitis.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Amikacin
- Anti-Bacterial Agents
- Clarithromycin
- Ethambutol
- Humans
- Male
- Maxillary Sinusitis
- Mycobacterium avium Complex
- Mycobacterium avium-intracellulare Infection
- Rifabutin
- Sinusitis
Other ID:
UI: 102213848
From Meeting Abstracts