PNEUMONIA CAUSED BY AN ATYPICAL MYCOBACTE RIUM IN AIDS

A 38-year-old man, HIV-positive for 6 years, developed fever and cough with deterioration in his general state. Chest radiography demonstrat ed an infiltration in the left upper lobe and computed tomography show ed a septated cavity. Three bronchioalveolar lavages over 4 weeks reco vered Klebsiella, Candida, Pseudomonas and Staphylococcus in the lavag e fluid. Acid-fast rods were not found in any of the microscopic prepa rations. His clinical condition and the radiological findings deterior ated despite appropriate antibiotic administration. A further cavity o ccurred in the right upper lobe and the inflammatory infiltrations ext ended further. Although no acid-fast organism had been demonstrated, t uberculostatic treatment was begun (daily 300 mg isoniazid, 600 mg rif ampicin, 900 mg streptomycin, 2 g pyrazinamide). His general condition and the radiological findings rapidly improved. Four weeks after cult uring the lavage fluid atypical Mycobacterium xenopi was isolated. - T his case illustrates the difficulty of diagnosing an atypical mycobact erial infection. It takes time and effort, but it is of great importan ce because up to 50% of patients with AIDS contract such infection. Ea rly and appropriate treatment will significantly improve quality of li fe and life expectancy.