Case history
Case history #1
A 58-year-old white man with a 30-pack-year history of smoking and excessive alcohol use presents with a 6-month history of productive cough, weight loss, fever, and night sweats. The patient denies sick contacts or recent travel outside of the US. On exam, the patient appears cachectic, but is in no acute distress. Chest auscultation reveals crackles over the left upper posterior lung fields. There is no lymphadenopathy.
Case history #2
A 65-year-old white woman who is a lifelong nonsmoker presents with a 2-year history of cough. She denies weight loss, fever, or night sweats. There is no previous history of lung disease. On exam, she appears thin with scoliosis and pectus excavatum. Auscultation of the lungs reveals crackles over the right middle lung fields.
Other presentations
Mycobacterium avium complex (MAC) lymphadenitis is primarily a disease of children and presents with unilateral cervical lymphadenopathy. MAC in patients with HIV occurs in patients who are severely immunocompromised, as evidenced by CD4 T-cell counts under 50 cells/microliter. Unlike the pulmonary disease and cervical lymphadenitis noted in nonimmunocompromised patients, MAC in patients with low CD4 counts presents as a systemic febrile illness with sweating, fatigue, abdominal pain, and diarrhea, with relatively few focal findings. Hepatomegaly and/or splenomegaly may be present on physical exam. While intra-abdominal adenopathy is a common finding on imaging studies, peripheral lymphadenopathy is not a notable physical exam finding of the disease. The presentation of MAC in people on suppressive antiretroviral therapy may differ from that seen in people with untreated HIV, with more localized diseases such as pneumonia, lymphadenitis, skin and soft tissue abscesses, and osteomyelitis rather than disseminated disease.[7][8]
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