SHM Converge Scientific Abstract ePoster Gallery-Murky Waters: Mac Colitis Complicated by Chylous Ascites

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This case describes a 29-year-old man with HIV/AIDS on antiretroviral therapy who presented with three weeks of worsening abdominal pain and distension. He had a history of cryptococcal meningitis and previously diagnosed MAC colitis, which had been treated with clarithromycin and ethambutol. Ethambutol was stopped because of concern for optic neuritis, leaving him on macrolide monotherapy for several months.<br /><br />On exam, he had tense abdominal distension with a fluid wave. Labs showed anemia and elevated alkaline phosphatase. CT imaging demonstrated mesenteric soft tissue nodularity, retroperitoneal lymphadenopathy, large-volume ascites, and mesenteric edema. Paracentesis revealed chylous ascites, and ascitic fluid cultures grew MAC. His symptoms improved only temporarily after drainage, and the fluid rapidly reaccumulated.<br /><br />The authors discuss that disseminated MAC infection remains possible in patients with HIV despite ART, especially when CD4 counts are very low or there is prior opportunistic disease. Typical findings include nonspecific abdominal symptoms, anemia, and elevated alkaline phosphatase or LDH. In this case, the lymphadenopathy seen on CT suggested lymphatic obstruction from MAC infection as the cause of the chylous ascites.<br /><br />After a negative ophthalmologic evaluation, ethambutol was restarted and the patient was placed on azithromycin plus rifabutin. He later required repeat outpatient paracentesis for recurrent ascites.<br /><br />Key takeaways are that clinicians should consider MAC-related chylous ascites in immunocompromised patients with abdominal distension, use CT to assess for lymphatic obstruction, and treat MAC promptly with combination therapy including a macrolide plus ethambutol. If ethambutol must be stopped, a suitable alternative should be started quickly to avoid incomplete treatment and clinical worsening.

Asset Subtitle

Brianna VanNoy

Meta Tag

Author List Brianna VanNoy, Kyra Deep, Melanie Prestidge

Category Clinical Vignettes

Concept Mycobacterium avium complex

Concept Chylous Ascites

Concept HIV/AIDS

Concept Severe immunocompromise

Concept Lymphatic Obstruction

Distinguished Non-Finalist

Presenter Organization Ohio State University

Presenting Author Brianna VanNoy

Track Adult

Keywords

HIV/AIDS

disseminated MAC infection

chylous ascites

abdominal distension

retroperitoneal lymphadenopathy

mesenteric nodularity

antiretroviral therapy

ethambutol

macrolide monotherapy

opportunistic infection

Mycobacterium avium complex

Chylous Ascites

HIV/AIDS

Severe immunocompromise

Lymphatic Obstruction