Recurrence of disseminated mycobacterium avium intracellulare presenting as spondylodiscitis and epidural abscess in a patient with acquired immune deficiency syndrome (Aids)

Abstract

Background: Mycobacterium avium intracellulare complex (MAI) is a member of the non-tuberculous mycobacteria family, which can cause both pulmonary and non-pulmonary disease. In patients with advanced HIV, it is known to cause disseminated disease. We present a case of a 65-year-old man who has sex with men (MSM) with AIDS, found to have spondylodiscitis and an epidural abscess, who had recently completed treatment for disseminated MAI. The patient was a 65-year-old with AIDS secondary to HIV and a prior history of disseminated MAI, who pre-sented with severe back pain. Upon presentation to the hospital, an MRI was performed, which was sugges-tive of spondylodiscitis and an epidural abscess. He was taken to surgery for a minimally invasive T12-L1 lami-nectomy and evacuation of the epidural abscess. Both traditional cultures and acid-fast bacillus (AFB) cultures were negative. Due to worsening pain, he was taken back to surgery for a repeat debridement and biopsy. Repeat cultures were positive for MAI. He was started on rifabutin, ethambutol, azithromycin, and moxifloxa-cin. Moxifloxacin was subsequently discontinued. He has had problems tolerating the treatment regimen, but is planned to complete an 18-24-month course. For patients with AIDS who have a diagnosis of spondylodiscitis and an epidural abscess, an opportunistic infection such as MAI should be considered. A repeat biopsy should be considered if suspicion is still high, even despite initially negative cultures. Treatment regimens should be prolonged, despite difficulty with medication compliance.