Paradoxical reaction during treatment of tuberculous brain abscess in a patient with AIDS

Vidal, José Ernesto; Cimerman, Sérgio; Nogueira, Roberta Schiavon; Filho, Francisco Bonásser; Sztajnbok, Jaques; Silva, Paula R. Marques da; Lins, Diogo L.M.; Coelho, João F.G.S.

doi:10.1590/s0036-46652003000300012

Cited by 24 publications

(19 citation statements)

References 4 publications

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“…Neurological disease following initiation of ART due to inflammation associated with previously silent M. tuberculosis infection in the CNS is a particular concern and may have a poor outcome (93). Several studies describe expanding intracranial tuberculomas (11,34,35,118,120,148), and acute onset of TB meningitis has been reported (35).…”

Section: Introductionmentioning

confidence: 99%

Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

et al. 2009

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SUMMARY Up to one in four patients infected with human immunodeficiency virus type 1 and given antiretroviral therapy (ART) experiences inflammatory or cellular proliferative disease associated with a preexisting opportunistic infection, which may be subclinical. These immune restoration diseases (IRD) appear to result from the restoration of immunocompetence. IRD associated with intracellular pathogens are characterized by cellular immune responses and/or granulomatous inflammation. Mycobacterial and cryptococcal IRD are attributed to a pathological overproduction of Th1 cytokines. Clinicopathological characteristics of IRD associated with viral infections suggest different pathogenic mechanisms. For example, IRD associated with varicella-zoster virus or JC polyomavirus infection correlate with a CD8 T-cell response in the central nervous system. Exacerbations or de novo presentations of hepatitis associated with hepatitis C virus (HCV) infection following ART may also reflect restoration of pathogen-specific immune responses as titers of HCV-reactive antibodies rise in parallel with liver enzymes and plasma markers of T-cell activation. Correlations between immunological parameters assessed in longitudinal sample sets and clinical presentations are required to illuminate the diverse immunological scenarios described collectively as IRD. Here we present salient clinical features and review progress toward understanding their pathogeneses.

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Section: Introductionmentioning

confidence: 99%

Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

et al. 2009

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“…In 1998, Crump et al reported a biopsy-proven tuberculoma during IRIS after HAART was initiated [12]. Later, other cases of paradoxical worsening of brain tuberculoma or tuberculous meningitis were reported [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Brain tuberculosis-associated immune reconstitution inflammatory syndrome in an HIV-positive patient: a biopsy-proven case

Giancola

Baldini

Carapella³

et al. 2015

J Infect Dev Ctries

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The case of an HIV-infected man from Eritrea previously diagnosed with tuberculosis, who presented neurological impairment and cerebral lesion after having voluntarily stopped anti-tubercular and antiretroviral therapies, is here reported. Treatments associated with steroids and mannitol were administered. The patient's condition improved, but neuroimaging showed a continuous worsening of the lesion, while a great immunological reconstitution was observed. Brain microsurgery was performed. A tuberculosis diagnosis was supported by pathological and microbiological examinations. Tuberculosis arising during immune reconstitution inflammatory syndrome is a complication of antiretroviral treatment and is considered to be an emerging disorder, especially in countries highly endemic for tuberculosis.

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“…Tuberculous brain abscess is a very rare presentation of IRIS. [4][5][6] It is important to diagnose or rule out TB before starting ART. To avoid paradoxical IRIS, it is ideal to treat TB for 2 to 8 weeks.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Immune Reconstitution Inflammatory Syndrome of Tuberculous Brain Infection in People Living with HIV/AIDS

Raja

Chokkalingam

Krishnarajasekhar

et al. 2013

J Int Assoc Provid AIDS Care

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HIV infection has changed the scenario of infectious disease. HIV-associated immunodeficiency resulted in a wide spectrum of new opportunistic infections. After introduction of antiretroviral therapy (ART), immune reconstitution inflammatory syndrome (IRIS) became an important challenge in management of 10% to 25% of the patients. Meta-analyses of IRIS from various reports published worldwide by Monika Muller et al described 12% IRIS incidence and 15.7% IRIS tuberculosis. Among IRIS tuberculosis, central nervous system involvement with IRIS tuberculous meningitis forms only 7%. Only 9 cases of tuberculous brain abscess is reported in patients with AIDS so far. The IRIS tuberculous brain abscess is very rare, and so far only 1 case is reported as a paradoxical reaction after ART initiation. Here, we report a case of recurrent IRIS tuberculosis meningitis and brain abscess.

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Paradoxical reaction during treatment of tuberculous brain abscess in a patient with AIDS

Cited by 24 publications

References 4 publications

Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

Brain tuberculosis-associated immune reconstitution inflammatory syndrome in an HIV-positive patient: a biopsy-proven case

Recurrent Immune Reconstitution Inflammatory Syndrome of Tuberculous Brain Infection in People Living with HIV/AIDS

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