DISSEMINATED MYCOBACTERIUM-AVIUM COMPLEX REVIEW OF GA-67 AND TL-201 SCANS AND AUTOPSY FINDINGS

A retrospective analysis of the files and Ga-67 scan findings of 32 AI DS patients with established diagnosis of disseminated Mycobacterium a vium complex (MAC) was conducted in order to determine the sensitivity of Ga-67 scans for the diagnosis of this disease and the sites of MAC organ involvement, Fourteen of the 32 patients had early and delayed TI-201 scans that were also reviewed, Autopsy findings of AIDS patient s in the 5 years (January 1990 to December 1994) were reviewed to dete rmine the incidence and sites of involvement of disseminated MAC in AI DS autopsies, Chest x-ray was positive in only 41% of patients, Ga-67 scans were positive in 84% with multi-lymph node sites of involvement in 78% (hilar lymph nodes in 37.5%, supraclavicular 28.1% [all were on the left side], para-aortic 31.2%, paratracheal 18.2%, mediastinal no des 6.2%, and axillary 3.1%), lung parenchymal in 18.7% and pleural in 9.3%), Increased uptake in the spleen in 16%, colitis 53.1% and enter itis 18.7%, Kaposi sarcoma in 9.3% and malignant lymphoma in 3.1%, TI- 201 scans were only positive in 6 of 14 patients (42.8%), The autopsy data found the incidence of disseminated MAC in 23.7% (54 patients) ou t of a total of 228 autopsies, Approximately half of these cases (52%) were diagnosed antemortem, Other opportunistic infections were identi fied in 74%, The most common sites of MAC involvement were lymph nodes (74%), spleen (74%), liver (52%), lungs (22%), colon (13%), small bow el (11%), and bone marrow (9%), Associated Kaposi sarcoma was detected in 22% and non-Hodgkin's lymphoma in 13%, Problems in antemortem diag nosis were due to nonspecific presentations, involvement of intrathora cic and extrathoracic lymph nodes, liver, spleen and colon; and the hi gher incidence of opportunistic infections and negative chest x-ray in the majority of the patients.