433. A Rare Case of Atypical Mycobacterium Associated Spinal Cord Compression
Session: Poster Abstract Session: HIV Challenges and Complications
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • Poster_for_IDSA_100411.pdf (897.5 kB)
  • Background: Mycobacterium avium-intracellulare complex (MAC) is prevalent in the environment and a common opportunistic bacterial infection in immunocompromised patients.  However, localized infection in the vertebral spine and epidural space remains uncommon.  In review of the literature, we identified six other cases of MAC-associated vertebral infection.1,6,7,8 (Table 1) We present a patient with a rare case of atraumatic MAC lumbar osteomyelitis and epidural abscess with acute spinal cord

     

    Methods: A 50 year-old Caucasian woman presented to the emergency room with a two-month history of atraumatic, progressive, bilateral hip and leg pain, which had progressed to an inability to ambulate.  Past medical history was significant for AIDS, recent Pneumocystis jiroveci pneumonia, and diabetes mellitus.  The patient was taking Atovaquone, Atripla, as well as Azithromycin for MAC prophylaxis.  The patient's CD4+ T-lymphocyte count was 39 cells/ÁL.    

    Results: An MRI of the lumbar spine revealed an epidural mass at L1 and associated compression of the conus medullaris. (Figure 1)  The patient was taken emergently to the operating room for decompression of the lumbar mass via a T12-L1 laminectomy.  A large, necrotic, purple, fluid-like mass was noted.  Testing demonstrated necrotizing granulomatous inflammation, bony destruction and rare acid fast bacilli. (Figure 2 A,B)  The patient was placed on azithromycin, atovaquone, ciprofloxacin, doxycycline, ethambutol, isoniazid, rifampin, Vitamin B6, and Vitamin B12.

    Six weeks later, the final culture yielded a diagnosis of MAC epidural abscess, with associated vertebral osteomyelitis and conus medullaris syndrome.

    Conclusion: MAC associated musculoskeletal infection is extremely rare.  To date we have identified only six other cases in the literature of similar MAC-associated vertebral osteomyelitis and epidural abscess in HIV-AIDS patients.  We hope that our case presentation will add to the existing literature and highlight the continued need to consider atypical mycobacterial infection as a cause of unremitting back pain in immunocompromised individuals, especially those who have been recently diagnosed and having received less than 12 months of prophylactic therapy.

     


    Subject Category: H. HIV/AIDS and other retroviruses

    Laurie Matt, MD, MPH, Internal Medicine, Akron General Medical Center, Akron, OH, Colleen Calvey, MD, Orthopaedic Surgery, Akron General Medical Center, Akron, OH, Kamel Muakkassa, MD, Neurosurgery, Akron General Medical Center, Akron, OH, David Watkins, MD, Infectious Disease, Akron General Medical Center, Akron, OH, Eric Speakman, MD, Pathology, Akron General Medical Center, Akron, OH and Nairmeen Haller, Ph.D, Akron General Medical Center, Akron, OH

    Disclosures:

    L. Matt, None

    C. Calvey, None

    K. Muakkassa, None

    D. Watkins, None

    E. Speakman, None

    N. Haller, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.