Cerebral tuberculomas in AIDS patients: a forgotten diagnosis?

Abstract

-The human immunodeficiency virus (HIV) infection epidemics increased the prevalence, multi-drug resistance and disseminated forms of tuberculosis. The central nervous system (CNS) tuberculosis has high mortality and morbidity, and it is usually divided into diffuse (meningitis) and localized (tuberculoma and abscess) forms. We report three cases of cerebral tuberculomas in AIDS patients: one with definitive diagnosis, confirmed with histopathology, and two with probable diagnosis, based on clinical information, radiological images, Mycobaterium tuberculosis isolation out of the CNS and adequate response to antituberculous treatment. Further, we discuss diagnostic, therapeutic and prognostic issues of tuberculomas, with emphasis in the distinction from cerebral tuberculous abscesses. Despite of their infrequent presentation, tuberculomas should be considered in the differential diagnosis of cerebral expansive lesions in patients with AIDS.KEY WORDS: tuberculoma, tuberculosis, central nervous system, acquired immunodeficiency syndrome. Tuberculomas cerebrais em pacientes com aids: um diagnóstico esquecido?RESUMO -A epidemia da infecção pelo vírus da imunodeficiência humana (HIV) aumentou a prevalência, multiresistência e formas disseminadas da tuberculose. O acometimento neurológico da tuberculose apresenta elevada morbidade e mortalidade, classificando-se em formas difusas (meningite) e localizadas (tuberculoma e abscesso). Relatamos três casos de tuberculomas cerebrais em pacientes com AIDS: um deles com diagnóstico definitivo, confirmado com histopatologia e dois com diagnóstico provável, baseado em informação clínica, radiológica, isolamento de Mycobaterium tuberculosis fora do sistema nervoso central e adequada resposta ao tratamento tuberculostático. Discutimos também aspectos diagnósticos, terapêu-ticos e prognósticos dos tuberculomas, enfatizando suas diferenças com os abscesos tuberculosos cerebrais. Apesar de serem relatados de forma infreqüente, os tuberculomas devem sempre ser considerados no diagnóstico diferencial das lesões expansivas cerebrais em pacientes com AIDS. PALAVRAS-CHAVE: tuberculoma, tuberculose, sistema nervoso central, sindrome da imunodeficiência adquirida.Tuberculosis (TB) has become more frequent since the emergence of human immunodeficiency virus (HIV) infection epidemics. Nowadays, there are important challenges, which complicate the management of HIV-TB co-infected patients. Among them, it is emphasized the increase of disseminated and extra-pulmonary TB forms, the multi-drug resistance and the increase in mortality 1 . The central nervous system (CNS) TB is found in 5-10% of patients with pulmonary TB 2 . These cases correspond to either latent infection reactivations or disseminated infections. Tuberculous meningitis is the most common clinical form and it is five times more frequent in patients with HIV infection than in patients without it 3 . The focal forms of CNS tuberculosis are infrequently described and they are divided into tuberculoma and abscess 4 . We desc...

Toxoplasmosis in HIV/AIDS Patients - A Living Legacy

“…While, focal forms of cerebral tuberculosis (tuberculoma and, less likely tuberculous brain abscess) allow for differential diagnosis of CT mainly in developing countries (Trujillo et al, 2005). Primary CNS lymphoma usually presents with a CD4 count of less than 50 cells/cumm, CT occurs below 100 cells/cumm, and cerebral TB is more frequently present with a CD4 count above 200 cells/cumm (Vidal et al, 2004a;Vidal et al, 2005a;Vidal et al, 2005b). In addition to these more common neurological diseases, the differential diagnosis of CT includes other opportunistic infections such as progressive multifocal leucoencephalopathy, herpes simplex encephalitis, and cryptococcal meningitis; AIDS-and non-AIDS-associated tumors such as metastases of disseminated lymphoma and glioblastoma multiforme, respectively; and vascular diseases.…”

Brain abscess due to viridans streptococci in a severely immunosuppressed HIV-infected patient

“…13 In a previous report, a patient with tuberculous brain abscess had undergone trepanation on the first day of hospital admission, suggesting that this more invasive approach is necessary in some instances. 14 CT scan is not as sensitive as MRI for the diagnosis of brain abscess but can frequently be obtained more easily on an emergent basis and is more available in developing countries. In the present case, the CT findings at admission were unspecific, and empirical treatment was started.…”

Evolution of Caseating Granuloma from Tuberculous Cerebritis in the Corpus Callosum

“…Furthermore, tuberculomas may show characteristics generally described for tuberculous brain abscess, including larger size (>3 cm in diameter), thin walls, presence of a single lesion, and multiloculation. 10 The differential diagnosis for tuberculoma includes mainly other granulomatous diseases (sarcoidosis, fungal lesions, and parasitic disease), primary neoplasms, and metastatic neoplasm. Imaging characteristics of tuberculoma may be non-specific.…”