Cerebral tuberculosis in patients with the acquired immunodeficiency syndrome (AIDS). Report of 6 cases and review.
Cerebral tuberculosis (TB) was diagnosed in 6 (4%) of 156 HIV-infected patients with TB seen at our institution over 6 years. We describe here the clinical and radiologic features of these cases and of 15 others reported in the literature. Of the 21 patients, 59% were intravenous drug users. Presenting symptoms were fever (76%), confusion (52%), seizures (38%), and headache (38%). Fourteen patients (66%) had previous or active extracerebral TB at presentation. Cranial CT scan showed ring-(62%) or nodular-(24%) enhancing lesions or mixed forms (14%). Among the 12 patients who underwent a brain biopsy, bacteriologic evidence of TB was found in 9. Four patients (19%) died during hospitalization. Among the 17 others who received antituberculous therapy, only 1 developed neurologic sequelae. Five patients also received steroid therapy to control cerebral edema or paradoxical growth of the cerebral mass lesions. TB should be considered as a cause of cerebral mass lesions in HIV-infected patients, especially if tuberculous infection is suspected at other sites.
Lesprit
P
P
Clinique des Maladies Infectieuses, Hôpital Saint-Louis, Paris, France.
Zagdanski
A M
AM
de La Blanchardière
A
A
Rouveau
M
M
Decazes
J M
JM
Frija
J
J
Lagrange
P
P
Modaï
J
J
Molina
J M
JM
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001927:Brain Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D010784:Photomicrography; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014376:Tuberculosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology
D000995:Antitubercular Agents