Rare HIV/AIDS Case Highlights Need for Atypical Focal Infections Diagnosis

Strategic Insights -

A 35-year-old man with newly diagnosed HIV presented with chronic cough, fever, abdominal discomfort, and pancytopenia, ultimately being diagnosed with a rare case of disseminated Mycobacterium avium complex (MAC) presenting with a solitary splenic abscess. This condition is a common opportunistic infection in advanced human immunodeficiency virus (HIV) but splenic abscess formation is rare. The patient was treated with rifabutin, ethambutol, and azithromycin and started on antiretroviral therapy (ART) during admission.

Key Takeaways:

  • The case highlights the importance of considering atypical focal infections in advanced HIV, which can lead to serious complications if left untreated.
  • Disseminated MAC is a common opportunistic infection in advanced HIV, but splenic abscess formation is rare.
  • The patient's symptoms, including chronic cough, fever, abdominal discomfort, and pancytopenia, were indicative of a more severe infection than initially suspected.
  • The diagnosis was made possible through imaging and cultures from multiple sites, including sputum, stool, and abscess drainage.
  • The patient's medical history, including cytomegalovirus viremia, esophageal candidiasis, and MAC-related granulomatous hepatitis, contributed to the complexity of the case.
  • Treatment with rifabutin, ethambutol, and azithromycin, along with antiretroviral therapy (ART), was successful in addressing the infection.
  • The case underscores the need for healthcare providers to be vigilant in diagnosing and treating opportunistic infections in patients with advanced HIV.

Statistics:

  • The patient was 35 years old, and his HIV diagnosis was newly confirmed.
  • He presented with chronic cough, fever, abdominal discomfort, and pancytopenia, which are common symptoms of advanced HIV.
  • The patient's medical history included cytomegalovirus viremia, esophageal candidiasis, and MAC-related granulomatous hepatitis, which contributed to the complexity of the case.
  • The treatment regimen included rifabutin, ethambutol, and azithromycin, in addition to antiretroviral therapy (ART).

Sources:

  • International Journal of STD & AIDS, 2025: 9564624251391236
  • Disseminated Mycobacterium avium complex presenting with solitary splenic abscess in an immunocompromised patient. (Sage Publications Ltd, 2025)
  • AIDS Weekly. Reports from Boston University Provide New Insights into HIV/AIDS (Disseminated Mycobacteriumavium complex presenting with solitary splenic abscess in an immunocompromised patient). November 3, 2025; p 86.