Meningo-Encephalitis Associated to Secondary Cerebral Vasculitis in a Patient with Disseminated Mycobacterium Avium Complex Infection and AIDS (P1.303)

OBJECTIVE To report a case of meningo-encephalitis associated with cerebral vasculitis(MACV) in a patient with disseminated mycobacterium avium complex(MAC) infection and acquired immunodeficiency syndrome(AIDS). BACKGROUND Infection with MAC causes aggressively disseminated disease in immunocompromised patients. However, central nervous system involvement is uncommon, presented mostly as meningitis and rarely as intraparenchymal abscesses. We report a case of MACV in an AIDS patient with disseminated MAC infection. DESIGN/METHODS Case report. RESULTS A-43-years-old male with a recent diagnosis of AIDS and Pneumocystis Jirovecii pneumonia was admitted due to a decreased level of consciousness, hallucinations, neck stiffness and generalized myoclonus. Initial brain MRI and CSF were normal. High intensity antiretroviral treatment was initiated with neurological recovery after 1 week. After 15 days a new rapidly neurological deterioration required ICU management; a second MRI revealed meningeal enhancement and acute infarctions in multiple territories with narrowing of both middle cerebral arteries. CSF analysis unveils 162 mononuclear cells, glucose:30mg[percnt], and proteins:650mg[percnt]. Ziehl-Neelsen test was positive. The patient developed persistent fever, cholestasis, hepatitis and pancytopenia. Blood and bone marrow cultures were positive for MAC. Treatment with isoniazid, pyrazinamide, ethambutol, clarithromycin, rifampin and levofloxacin was performed. Despite treatment, a clinical worsening with a decreased level of consciousness, severe tetraparesis and seizures were observed. The case was interpreted as MACV in a context of disseminated MAC infection, and higher doses of dexamethasone were added. Nevertheless, the patient died after fifteen days from diagnosis. CONCLUSIONS To our knowledge, this is the first case report of CNS vasculitis as a complication of disseminated MAC infection. An aggressive and refractory to treatment evolution were hallmarks features of this case. The underlying pathophysiology of the vasculitis is unknown and might be related either to MAC itself, the immune reconstitution due to antiretroviral initiation or most probably to a combination of both them Disclosure: Dr. Ballesteros has nothing to disclose. Dr. Garino has nothing to disclose. Dr. Consalvo has nothing to disclose. Dr. Imhoff-Jullier has nothing to disclose. Dr. Giacchino has nothing to disclose. Dr. Fernandez Suarez has nothing to disclose. Dr. Russo has nothing to disclose. Dr. Gomez has nothing to disclose. Dr. Leiguarda has nothing to disclose.