HYPOSPLENISM FROM MYCOBACTERIUM-AVIUM COMPLEX INFECTION IN A PATIENT WITH AIDS AND IMMUNE THROMBOCYTOPENIA

We describe a patient with HIV-related immune thrombocytopenic purpura with known Mycobacterium avium complex (MAC) infection presenting wit h intracerebral hemorrhage associated with severe thrombocytopenia who failed splenectomy following unsuccessful trials of corticosteroids a nd intravenous immunoglobulin, His presplenectomy peripheral blood sme ar showed Howell-Jolly bodies and microscopic examination of his splee n demonstrated multiple granulomas with numerous acid-fast organisms r eplacing the normal splenic tissue. We postulate that splenic hypofunc tion secondary to overwhelming MAC infection contributed to the failur e of the thrombocytopenia to promptly respond to splenectomy.