A Case of Mycobacterium avium Complex Vertebral Osteomyelitis in a Patient With Human Immunodeficiency Virus

Mycobacterium avium complex (MAC) infection is one of the most common bacterial opportunistic infections in persons living with human immunodeficiency virus (PLWH). Mycobacterium avium complex infections are caused by either M. avium or Mycobacterium intracellulare, which are nontuberculous mycobacterial species. Mycobacterium avium complex is prevalent in soil, water, and animals in the environment. Mycobacterium avium complex infections are commonly seen in persons with CD4 counts less than 50 cells/μL and are the most common cause of disseminated disease in immunocompromised patients. Vertebral osteomyelitis caused by MAC, however, remains uncommon in PLWH, with few cases reported in the literature (Lancet Infect Dis. 2004;4:557–565; Infect Dis Clin Pract. 2001;10:17–20). We present a case of vertebral osteomyelitis secondary to MAC in a person with human immunodeficiency virus and compare 10 other cases reported in the literature. Our case also highlights the importance of resuming secondary MAC prophylaxis when CD4 counts decline below 100 cells/μL in PLWH.