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

Abstract

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.

Tuberculous Meningitis in Patients Living with HIV

“…Neurological TB, occurs in 5 to 8% in HIV infected patients; five times more frequent than in patients without HIV [6,9]. TBM accounts for approximately 1% of all cases of TB [5]. This study founded that the prevalence of TBM in HIV infected patient at the UHC of Casablanca was 1,43%.…”

“…TBM is one of the most severe and lethal complications of TB [5]. TBM is caused by the hematogenous spread of the bacilli, from pulmonary TB or from the rupture of subependymal tubercle into the subarachnoid space [6,7].…”

Tuberkuloma Serebral Pada Penderita Acquired Immune Deficiency Syndrome

“…Faktor resiko yang berperan selain usia anak-anak dan koinfeksi HIV adalah malnutrisi, malignansi, dan penggunaan alkohol, rokok tembakau, dan agen imunosupresif. [3][4][5] Perkembangan penyakit ini berasal dari kompleks primer yang berisi bakteri basil MT yang menyebar secara hematogen dan menginfiltrasi meninges saat infeksi primer. Fokus ini tidak selalu ruptur di lapisan dura otak, namun secara lokal menyebar dan membentuk granuloma di di antara parenkim otak.…”

A Scarce Presentation of <i>Mycobacterium tuberculosis</i>, Case Report

“…Similar to HIV patients with immune suppression [2] [9] [10], pregnancy and post-partum state adversely affects women's immune system that exposes them to higher risk of quiescent infections reactivation. Studies regarding pregnant women reported [11]. In this report, we propound an odd display of CNS tuberculoma in a young post-partum female who had been referred to us with seizure and altered mental status.…”