Spontaneous Resolution of Endobronchial Mycobacterium Avium-intracellulare Infection in a Patient with AIDS

Abstract

Cardiac involvement is common in patients with the acquired immunodeficiency syndrome (AIDS) and, when symptomatic, it portends a poor prognosis. We present a case of marked spontaneous regression of cardiomyopathy in a patient with AIDS. To our knowledge, this is the first reported case of spontaneous recovery of ventricular function in an AIDS patient.

Case Details

Clinical Characteristics

Massive hemoptysis, fresh clot in the posterior segment of the right upper lobe bronchus, multiple, partially obstructing, polypoid endobronchial lesions, necrotizing and non-necrotizing granulomas, recurrent hemoptysis, fever, chest radiograph typical of bronchiectasis, recurrent maxillary sinusitis resistant to multiple courses of antibiotics, progressive bilateral, interstitial lower lobe infiltrates, progressive cmv retinitis

Remission Characteristics

Absence of polypoid airway masses, unremarkable transbronchial biopsies, negative cultures for mai organisms

Treatment & Mechanisms

Proposed Remission Mechanisms

Parenchymal mai is self-limiting or immunologic reconstitution, perhaps aided by zidovudine and gamma globulin

Clinical Treatment

Bronchial artery embolization, endobronchial examination, removal of polypoid masses, bronchoscopy, transbronchial biopsies

Non-Clinical Treatment

Zidovudine, gamma globulin, amoxicillinclavulanate, ciprofloxacin, erythromycin, tetracycline, cefadroxil, aerosolized pentamidine, dhpg, cyclic antibiotics

Additional Notes

The patient continued to experience frequent bouts of sinusitis and minor episodes of hemoptysis. During September 1989 his sputum cultures again turned positive for MAI. However, bronchoscopy performed on October 10, 1989, revealed no bleeding source or evidence of recurrence of endobronchial MAI.