[Intracerebral tuberculoma in HIV infection. Epidemiology and contribution of magnetic resonance imaging].
Intracerebral tuberculomas, observed in two HIV-infected patients, illustrated the diagnostic and therapeutic problems involved when an intracranial formation is discovered in this clinical situation. Both patients had a history of pulmonary tuberculosis. No preventive treatment had been given and disseminated tuberculosis occurred within a short delay (less than 2 years). A neurological deficiency led to the discovery of intracranial formations. The lack of effect of anti-toxoplasmosis therapy and the simultaneous discovery of tuberculous lesions strongly suggested intracerebral tuberculoma. With antituberculosis treatment, the general signs disappeared rapidly. Magnetic resonance imaging was particularly useful for following the course of the intracerebral lesions with a stereotype structure (confluent polylobular abscesses), for eliminating rapid evolution which would suggest lymphoma, the main differential diagnosis and to indicate corticosteroid treatment due to persistent oedema. Outcome was favourable with anti-tuberculosis therapy and corticosteroids. Intracerebral tuberculomas are rare and should be entertained in patients with tuberculosis when intracerebral abscesses do not respond to antitoxoplasmosis therapy. Magnetic resonance imaging is the most adapted imaging technique for diagnosis and follow-up.
Lecuit
M
M
Service des Maladies infectieuses, parasitaires et tropicales. Groupe hospitalier Pitié-Salpêtrière, Paris.
Rogeaux
O
O
Bricaire
F
F
Gentilini
M
M
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011241:Prednisone / Q000627:therapeutic use; D016781:Toxoplasmosis, Cerebral / Q000150:complications* / Q000188:drug therapy; D016862:Tuberculoma, Intracranial / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000188:drug therapy
D000995:Antitubercular Agents; D011241:Prednisone
Tuberculomes intracérébraux au cours de l'infection par le VIH. Epidémiologie et apport de l'imagerie par résonance magnétique.