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Mycobacterium avium complex causing endobronchial disease in AIDS patients after partial immune restoration
P B Bartley1, A M Allworth, D P Eisen
1Infectious Diseases Unit, Wattlebrae, Royal Brisbane Hospital Herston, Australia.
Objective:
To report the development of an unusual manifestation of pulmonary Mycobacterium avium complex (MAC) infection in two patients with the acquired immune-deficiency syndrome (AIDS) after the commencement of combination antiretroviral chemotherapy.
Patients:
Two Caucasian males with human immunodeficiency virus (HIV) infection and CD4 lymphocyte counts <0.05 x 10x9/1 and with plasma HIV polymerase chain reaction (PCR) >100,000 copies/ml who were commenced on combination antiretroviral chemotherapy including a protease inhibitor.
Results:
Both patients developed endobronchial polypoid tumours within two months of commencing antiretroviral chemotherapy. Histology demonstrated granuloma formation and acid-fast bacilli. Tissue from both patients grew M. avium. Both patients achieved significant suppression of viral replication and had significantly improved CD4 lymphocyte counts. Both required antimycobacterial therapy.
Conclusions:
Endobronchial polypoid tumours due to MAC infection have only been described in HIV-infected patients receiving antiretroviral chemotherapy. A degree of restored immunity is implicated in the pathogenesis of this unusual disease.