Thanks to Dr. Godbole for an excellent case of disseminated MAC in a patient with HIV!

Learning Points:

-MAC are ubiquitous organisms which commonly cause disseminated disease in HIV patients with a CD4 count of <50.

-Common presentations include diarrhea, abdominal pain, fevers, weight loss, and lymphadenopathy. Diagnosis is confirmed by isolation of MAC from the blood, lymph nodes, or bone marrow.

-Treatment includes combination clarithromycin with ethambutol +/- rifabutin. Intestinal lymphangiectasia (as supected in the presented patient) can lead to malabsorption of HAART and MAC therapy causing refractory disease.

-Click here for a great review of opportunistic MAC infection in HIV patients.