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Fatal pericarditis due to Mycobacterium avium-intracellulare in acquired immunodeficiency syndrome
1Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha 68105.
Abstract:
A 27-year-old white male homosexual with AIDS presented 19 months after the initial diagnosis with persistent fever, marked dyspnea at rest, and severe substernal pain in the chest. A pericardial friction rub was auscultated, and an effusion was demonstrated echocardiographically. Pericardiocentesis yielded 220 ml of serosanguinous fluid. Special stains of the fluid for microorganisms were negative. A mycobacterial infection was suspected, and therapy with multiple antimycobacterial agents was initiated. Cultures of the fluid eventually yielded MAI. Despite therapy, cardiac function declined, and the patient died two months after presentation. Autopsy confirmed the diagnosis of chronic pericarditis due to MAI. Pericarditis due to MAI should be included in the differential diagnosis of cardiac dysfunction in patients with AIDS.
Insights
A case of persistent fever and chest pain in an AIDS patient revealed pericarditis caused by Mycobacterium avium intracellulare (MAI). This diagnosis should be considered in cardiac dysfunction among AIDS patients.
Area of Science:
- Infectious Diseases
- Cardiology
- Immunology
Background:
- Acquired Immunodeficiency Syndrome (AIDS) is associated with opportunistic infections affecting multiple organ systems.
- Cardiac complications, including pericardial effusion and myocarditis, can occur in patients with advanced HIV infection.
- Mycobacterium avium intracellulare (MAI) is an opportunistic pathogen that can cause disseminated disease in immunocompromised individuals.
Observation:
- A 27-year-old homosexual male with AIDS presented with persistent fever, dyspnea, and chest pain 19 months post-diagnosis.
- Physical examination revealed a pericardial friction rub, and echocardiography confirmed a pericardial effusion.
- Initial diagnostic workup of the pericardial fluid was negative for common microorganisms.
Findings:
- Despite empiric antimycobacterial therapy, the patient's condition worsened, leading to cardiac dysfunction and death.
- Cultures of the pericardial fluid eventually identified Mycobacterium avium intracellulare (MAI) as the causative agent.
- Autopsy confirmed chronic pericarditis due to MAI.
Implications:
- Pericarditis due to MAI represents a rare but serious complication in patients with AIDS.
- MAI pericarditis should be considered in the differential diagnosis of cardiac dysfunction, particularly in HIV-infected individuals presenting with unexplained fever and chest symptoms.
- Early recognition and targeted therapy for MAI infection may be crucial for improving outcomes in affected patients.