P2736 - Unmasking the Unusual: An Uncommon Presentation of Disseminated Mycobacterial Infection in a Young Immunocompromised Patient

Navkiran Randhawa, DO¹, Yasmeen Shahout, ¹, Prabhat Kumar, MD², Gaurav Gopu, ³, Humberto Sifuentes, MD^4
1Medical College of Georgia at Augusta University, Augusta, GA; ²Cleveland Clinic Foundation, Cleveland, OH; ³Medical College of Georgia at Augusta University, Cumming, GA; ⁴Augusta University, Augusta, GA

Introduction: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) increases patients' risks for opportunistic infections such as mycobacterium avium complex. However, disseminated mycobacterial infection (MAC) involving the gastrointestinal tract is rare and commonly can be missed due to vague clinical presentations such as persistent diarrhea, abdominal pain, and significant weight loss, often leading to delayed diagnosis. We present a rare case of MAC presenting with odynophagia and unintentional weight loss in a young male.

Case Description/Methods: A 31 year old male with a past medical history with HIV/AIDS noncompliant with medication and seizure disorder presented with weeks of odynophagia and weight loss. On admission, the patient was afebrile and hemodynamically stable. Labs revealed WBC of 6.9 10 × 3 uL, hemoglobin 9.3 g/dL and platelet count 265 10 × 3 uL , absolute CD4 cell count was 47. Physical exam revealed a thin, frail male with diffuse abdominal tenderness. Esophagogastroduodenoscopy revealed normal esophagus and stomach with lymphangiectasia of duodenum. His flexible sigmoidoscopy revealed normal colonic mucosa. Gastric biopsies revealed chronic gastritis but duodenal and colonic biopsies revealed acid-fast bacilli consistent with disseminated MAC. Patient was started on azithromycin 500mg daily, rifampin 300mg BID, and ethambutol 800mg daily. The patient's odynophagia and abdominal pain improved with initiation of medications.

Discussion: This case underscores the clinical challenges and diagnostic complexity associated with MAC infection in patients with advanced HIV/AIDS. This patient's presentation was complicated by odynophagia, an atypical symptom for disseminated MAC, emphasizing the importance of high clinical suspicion in immunocompromised patients presenting with gastrointestinal manifestations. Early identification and appropriate antimycobacterial therapy are crucial for patient recovery, as demonstrated by the significant clinical improvement observed in our patient.


Disclosures:


Navkiran Randhawa, DO¹, Yasmeen Shahout, ¹, Prabhat Kumar, MD², Gaurav Gopu, ³, Humberto Sifuentes, MD⁴. P2736 - Unmasking the Unusual: An Uncommon Presentation of Disseminated Mycobacterial Infection in a Young Immunocompromised Patient, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.