Choo P S, McCormack J G
University Department of Medicine, University of Queensland, South Brisbane, Australia.
J Infect. 1995 Jan;30(1):55-8. doi: 10.1016/s0163-4453(95)92899-5.
We present a patient with a very large pericardial effusion due to disseminated Mycobacterium avium complex (MAC) infection with associated bacteraemia and gastroenteritis. He was HIV antibody-positive with a CD4+ lymphocyte count of 10 x 10(6)/l. He complained of fevers, diarrhoea and dyspnoea and an echocardiogram showed a pericardial effusion. Chest X-ray showed progressive enlargement of the cardiac silhouette over a 3-month period. The effusion was drained surgically and antimycobacterial therapy (clarithromycin, clofazamine, rifampicin, ciprofloxacin, amikacin) was initiated. The patient had complete resolution of his pericardial effusion both clinically and radiologically. Three other AIDS patients with pericardial effusions caused by MAC are described in the medical literature, two died of cardiac dysfunction shortly after diagnosis. There is a case described of MAC-related pericardial effusion in a HIV-negative immunocompetent patient which resolved antimycobacterial therapy. MAC should be included in the differential diagnosis of pericardial effusions in AIDS patients. A combination of medical therapy and surgical intervention may give rise to considerable clinical benefit especially if initiated early.
我们报告一例因播散性鸟分枝杆菌复合体（MAC）感染伴菌血症和肠胃炎导致大量心包积液的患者。他的HIV抗体呈阳性，CD4 +淋巴细胞计数为10×10⁶ /L。他主诉发热、腹泻和呼吸困难，超声心动图显示有心包积液。胸部X线显示在3个月内心脏轮廓逐渐增大。通过手术引流了积液，并开始进行抗分枝杆菌治疗（克拉霉素、氯法齐明、利福平、环丙沙星、阿米卡星）。患者的心包积液在临床和影像学上均完全消退。医学文献中描述了另外3例由MAC引起心包积液的艾滋病患者，其中2例在诊断后不久死于心脏功能障碍。有一例HIV阴性免疫功能正常的患者出现MAC相关心包积液，经抗分枝杆菌治疗后积液消退。MAC应纳入艾滋病患者心包积液的鉴别诊断。药物治疗和手术干预相结合可能会带来显著的临床益处，尤其是早期开始治疗时。
