Appendicitis in patients with acquired immunodeficiency syndrome

Previous reports evaluating appendicitis in patients with human immunodeficiency virus/ acquired immunodeficiency syndrome have detailed unusual pathology, atypical clinical presentations, and poor outcomes. These reports have described small groups of patients and are inconsistent with larger surveys.

A retrospective design was used to evaluate patients diagnosed with human immunodeficiency virus or acquired immunodeficiency syndrome undergoing appendectomy from 1986 to 1995.

Fifty-five patients were evaluated (mean age 33.4 +/- 8.2 years, 98 percent male, 90 percent clinical acquired immunodeficiency syndrome, CD4 count 144.45 +/- 34 cells/mL3). Presenting symptoms included right lower quadrant pain (91 percent), nausea and vomiting (41 percent), diarrhea (22 percent), and generalized abdominal pain (24 percent). Significant findings on examination included right lower quadrant tenderness (91 percent), rebound (74 percent), fever (54 percent), abdominal distention (7 percent), and generalized abdominal tenderness (9.3 percent). Computed tomography was performed in 26 percent and findings were suggestive of appendicitis in 93 percent of cases. Operative findings included acute inflammation (83.3 percent), appendiceal rupture (24 percent), gangrene (29 percent), and normal-appearing appendices (5.5 percent). Unusual findings included Mycobacterium tuberculosis (1.8 percent), atypical mycobacterium (1.8 percent), and chronic appendicitis (3.7 percent). Thirty-day survival was 100 percent. Significant postoperative fevers were noted in 33 percent and lasted 4.63 +/- 1.2 days. The presence of prolonged postoperative fever was linked to lower CD4 counts (p = .05). Follow-up (mean time to follow-up, 1,656 +/- 970 days) was complete in 43 percent. Survival at follow-up was noted in 57.1 percent (mean length of survival after surgery, 837 +/- 155 days).

Appendectomy in patients with human immunodeficiency virus/acquired immunodeficiency syndrome is associated with little morbidity or mortality. Atypical pathology is rarely identified. A higher than expected rate of rupture may be linked to delays before hospitalization or to impaired immune status.