Acid-fast bacilli on buffy coat smears in the acquired immunodeficiency syndrome: a lesson from Hansen's bacillus

A patient with the acquired immunodeficiency syndrome was found to have a continuous bacillemia of Mycobacterium avium-intracellulare by examination of Kinyoun-stained buffy coat smears. There were 29 cells/cu mm that contained acid-fast bacilli (AFB) and 1.5 X 10(5) AFB/ml of whole blood. The cells of the reticuloendothelial system were engorged with AFB, suggesting reticuloendothelial saturation. The peripheral blood involvement and magnitude of the mycobacterial burden are analogous to leprosy, and it is suggested that other similarities between the immunobiology of leprosy and disseminated M avium-intracellulare infection in the acquired immunodeficiency syndrome may exist.