A neck abscess one year after mycobacterial infection in a patient with human immunodeficiency virus: a diagnostic dilemma. Academic Article uri icon

abstract

  • A 52 year old Indian-born HIV-positive woman was admitted for investigation of a painful neck mass on 10 October 2006. She denied fever and weight loss and reported no recent travel or pet exposure. The patient was afebrile and physical examination was notable for a large tender mass of coalesced lymph nodes in the left suprascapular region. Her CD4 count was 382 cells/μl and viral load was undetectable. Computed tomography of the chest and abdomen demonstrated an abscess extending from C4 to the base of the left neck, as well as diffuse cervical lymphadenopathy, destruction of the supraspinatus, and a lytic lesion in the left scapula involving both sides of the bone suggestive of osteomyelitis [Figure A]. The lung fields were clear, the liver was normal, but numerous diffuse hypodense splenic lesions were observed. A left supraclavicular lymph node excisional biopsy was performed 2 days after admission. Bacterial and fungal cultures, mycobacterial stain and culture, periodic acid-Schiff, methenamine-silver, Giemsa stains and immunostains for Epstein-Barr virus and cytomegalovirus from the biopsy were negative. Elective scapular biopsy performed one month later revealed marrow and bone necrosis

publication date

  • January 1, 2012