Cerebral Mycobacterium avium infection in an HIV-infected patient following immune reconstitution and cessation of therapy for disseminated Mycobacterium avium complex infection

Reported here is a case of cerebral Mycobacterium avium complex infection t hat occurred in an HIV-infected patient, who had been treated for dissemina ted infection and had discontinued clarithromycin and ethambutol following a significant rise in his CD4+ T-cell count after starting highly active an tiretroviral therapy. He responded well to excision of the lesion and reins titution of multidrug therapy. Caution should be exercised when considering ceasing maintenance therapy for disseminated Mycobacterium avium complex i nfection in HIV-infected patients who demonstrate an apparently good immuno logic response to highly active antiretroviral therapy, as this response ma y not necessarily restore protective immunity against all opportunistic pat hogens.