Wrist Bone Enlargement/Fusion/Pain/Swelling (Possible MAC)

Question

For My Best Friend - Male with right wrist enlarged, joint damage (both fusion on thumb side of wrist & torn ligament plus enlargement of bone on opposite side of wrist (top of hand view). Causing wrist to be unuseable and appear to be malformed due to damage caused by swellin. X-ray, MRI, attempted extraction of fluid from wrist using needle guided xray (no fluid could be found for culture). Proposing surgery to get bone sample and tissue for examination (rule out MAC and/or sympathetic reflex dystrophy. Currently prescribed antiinflamatory INDOMETHACIN 75 MG 2XDAY and VICODIN to aid in swelling and pain as temporary workout. Patient has multiple OI's with long history of MAC infections (lymph glands under right arm swelling, bursting, then infection subsides). Currently taking following for MAC: Ethambutol 400 MG tablet, Azithromycin combination, tested and has been found resistant(1996) to other common MAC drugs.

Question: Any knowledge of similar cases or explanations for this that might be related to MAC, CMV, less than 120 t-cell, less than 400 viral load or HIV related diseases (got sick July 1995).

Any input would be extremely appreciated. This wrist problem started November 98 and progressed to this permanently damaged wrist, with continued pain, and fear of continued expansion within that area or to other areas of body.

Thanks for you help for my Best Friend.

Answer

The only way to get a clear answer about what isgoing on in your friend's wrist is a bone biopsy and culturesof the biopsy material. In some patients, especially those with low or undetectable viral loads, MAC can occur in isolated parts of the body, instead of being found in the blood.