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115 CHYLOUS ASCITES SECONDARY TO NON-TUBERCULOUS MYCOBACTERIAL INFECTION IN HIV INFECTION CS Wang1, JK Lee2, EM Yoshida2, P Phillips2 HIV-infected individuals are susceptible to non-tuberculous mycobacteria infection (NTMI) from severe immunosuppression, or following antiretroviral (ARV) therapy in immune reconstitution syndrome (IRS). The full spectrum of disease of NTMI in HIV is not yet completely defined. Chylous ascites, a rare type of ascites characterized by cream-coloured peritoneal fluid with a triglyceride level above 2.26 mmol/L (200 mg/dL), is not a commonly described manifestation of NTMI in HIV. Herein, we present the largest series to date (n=4) of patients with chylous ascites secondary to NTMI in the setting of HIV IRS.
Departments of Medicine, 1University of Toronto, Toronto, Ontario, 2University of British Columbia, Vancouver, British Columbia
Patients for the study were identified through an infectious disease specialist (PP) at St. Paul's Hospital in Vancouver, BC. A retrospective chart review was conducted for patient characteristics and treatment outcomes. A literature review was performed to identify published reports of chylous ascites in NTMI.
Four patients (all male, ages 34-40) were identified. All had received ARV therapy before diagnosis (range 10-24 months). Symptoms at presentation included abdominal pain (n=4), bloating (n=2), and diarrhea (n=1). Analysis of ascitic fluid showed triglyceride content 2.9-29.6 mmol/L, with no evidence of peritonitis (WBC 225-420 cells/mm3). Cultures of ascitic fluids were negative for NTM. Imaging demonstrated splenomegaly (n=3) and lymphadenopathy (n=3). NTMI was diagnosed by lymph node biopsy (n=2), liver biopsy (n=1), and detection of co-existent active pulmonary infection (n=1). Complete workup excluded other causes of chylous ascites. Three of 4 patients improved with NTM treatment. In review of existing literature, there have only been 4 previous individual case reports of NTMI-related chylous ascites; all occurred with HIV infection, but none were in the setting of IRS.
In conclusion, chylous ascites caused by NTMI is a rare and possibly under-recognized clinical entity, associated with immunodeficiency. When evaluating HIV-infected patients with chylous ascites, ascitic fluid culture alone does not appear sufficient to exclude infection, and tissue biopsy may be necessary to confirm or exclude NTMI.