SHM Converge Scientific Abstract ePoster Gallery-Disseminated Mac: A Challenging Differential for Back Pain in Hiv/Aids

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This case describes a 27-year-old man with advanced HIV/AIDS and poor adherence to antiretroviral therapy who presented with one month of severe worsening low back pain radiating to the upper back, associated with headache, fever, cachexia, and cervical lymphadenopathy. Initial evaluation, including chest X-ray, head CT, cerebrospinal fluid studies, and spinal assessment, did not identify a clear neurologic or structural cause. Laboratory findings showed anemia, leukopenia, and markedly elevated inflammatory markers, with a CD4 count of 20/mm³.<br /><br />Because of diffuse lymphadenopathy on imaging and concern for infection versus malignancy, an excisional lymph node biopsy was performed. The biopsy showed numerous acid-fast bacilli, but tuberculosis PCR was negative. Based on these findings, disseminated Mycobacterium avium complex (DMAC) was presumed, and treatment was started with azithromycin, ethambutol, and rifabutin while antiretroviral therapy was resumed. Tissue and fungal blood cultures later confirmed MAC after four weeks. The patient’s symptoms improved significantly after six weeks of therapy.<br /><br />The report emphasizes that MAC is the most common nontuberculous mycobacterial infection in HIV/AIDS, but disseminated MAC is now relatively uncommon. Typical presentations include constitutional symptoms, lymphadenopathy, and hepatosplenomegaly. In this patient, severe back pain was likely caused by bulky retroperitoneal lymphadenopathy, highlighting an unusual but important manifestation. The case underscores the need to include DMAC in the differential diagnosis of severe back pain in patients with advanced HIV and to consider early empiric therapy in high-risk patients while awaiting culture confirmation.

Asset Subtitle

Kemar O. Barrett

Meta Tag

Author List Kemar O. Barrett, Sofia Terner

Category Clinical Vignettes

Concept Mycobacterium avium complex

Concept Low Back Pain

Concept Retroperitoneal Lymphadenopathy

Concept HIV/AIDS

Concept Constitutional Symptoms

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Kemar O. Barrett

Track Adult

Keywords

advanced HIV/AIDS

disseminated Mycobacterium avium complex

severe low back pain

lymphadenopathy

acid-fast bacilli

CD4 count

antiretroviral therapy

nontuberculous mycobacterial infection

retroperitoneal lymphadenopathy

empiric therapy

Mycobacterium avium complex

Low Back Pain

Retroperitoneal Lymphadenopathy

HIV/AIDS

Constitutional Symptoms