SHM Converge Scientific Abstract ePoster Gallery-Hematuria, Intermittent Fever, and Retroperitoneal Lymphadenopathy; A Case of Mac.

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This case report describes a 52-year-old man with HIV/AIDS who presented with diffuse abdominal pain, suprapubic fullness, inguinal lymphadenopathy, fever, poor urine output, and painless hematuria. His CD4 count was severely low at 23 cells/µl, and initial imaging showed extensive retroperitoneal and mesenteric lymphadenopathy, raising concern for lymphoma or metastatic malignancy. CT-guided lymph node biopsy revealed acid-fast bacilli, and blood cultures confirmed disseminated Mycobacterium avium complex (MAC) infection.<br /><br />The case is notable because MAC can mimic malignancy, especially in immunocompromised patients, and retroperitoneal lymphadenopathy is a serious but common manifestation of disseminated MAC in AIDS. Although MAC typically affects the lymph nodes, spleen, liver, and bone marrow, this patient’s presentation with hematuria and abdominal symptoms initially suggested bladder lymphoma.<br /><br />Treatment included antiretroviral therapy (HAART/ART), which improved the patient’s CD4 count from 23 to 208 cells/µl within 45 days, along with anti-MAC therapy using a macrolide plus ethambutol. The patient improved clinically and gained weight. The report emphasizes that early recognition and prompt treatment are critical, with macrolide-based combination therapy as the mainstay of MAC management. ART is also essential because immune recovery helps control the infection and reduce relapse risk.<br /><br />The discussion notes that disseminated MAC often occurs when CD4 counts fall below 50 cells/µl and may cause abdominal pain, bowel obstruction, hepatosplenomegaly, or other serious complications. Future research should focus on MAC transmission, pathogenesis, and the influence of comorbidities and medications on disease risk and severity.

Asset Subtitle

Yohannes Haile

Meta Tag

Author List Allen Seylani, Yohannes Haile

Category Clinical Vignettes

Concept Mycobacterium avium complex

Concept Retroperitoneal Lymphadenopathy

Concept CD4 Count

Concept AFB Smear

Concept CD4 Count Below 50 Cells/µL

Distinguished Non-Finalist

Presenter Organization Ucr

Presenting Author Yohannes Haile

Track Adult

Keywords

HIV/AIDS

disseminated Mycobacterium avium complex

MAC infection

retroperitoneal lymphadenopathy

immunocompromised patient

acid-fast bacilli

hematuria

antiretroviral therapy

macrolide plus ethambutol

CD4 count

Mycobacterium avium complex

Retroperitoneal Lymphadenopathy

CD4 Count

AFB Smear

CD4 Count Below 50 Cells/µL