Meningo-Encephalitis Associated to Secondary Cerebral Vasculitis in a Patient with Disseminated Mycobacterium Avium Complex Infection and AIDS (P1.303)
Abstract
OBJECTIVE
To report a case of meningo-encephalitis associated with cerebral vasculitis(MACV) in a patient with disseminated mycobacterium avium complex(MAC) infection and acquired immunodeficiency syndrome(AIDS).
BACKGROUND
Infection with MAC causes aggressively disseminated disease in immunocompromised patients. However, central nervous system involvement is uncommon, presented mostly as meningitis and rarely as intraparenchymal abscesses. We report a case of MACV in an AIDS patient with disseminated MAC infection.
DESIGN/METHODS
Case report.
RESULTS
A-43-years-old male with a recent diagnosis of AIDS and Pneumocystis Jirovecii pneumonia was admitted due to a decreased level of consciousness, hallucinations, neck stiffness and generalized myoclonus. Initial brain MRI and CSF were normal. High intensity antiretroviral treatment was initiated with neurological recovery after 1 week. After 15 days a new rapidly neurological deterioration required ICU management; a second MRI revealed meningeal enhancement and acute infarctions in multiple territories with narrowing of both middle cerebral arteries. CSF analysis unveils 162 mononuclear cells, glucose:30mg[percnt], and proteins:650mg[percnt]. Ziehl-Neelsen test was positive. The patient developed persistent fever, cholestasis, hepatitis and pancytopenia. Blood and bone marrow cultures were positive for MAC. Treatment with isoniazid, pyrazinamide, ethambutol, clarithromycin, rifampin and levofloxacin was performed.
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