Cerebral tuberculomas in AIDS patients: a forgotten diagnosis?
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.
Department of Infectology, Institute of Infectious Disease Emilio Ribas, São Paulo SP, Brazil. jbermudez@emilioribas.sp.gov.br
José E
JE
Vidal
Adrián V
AV
Hernández
Augusto C Penalva de
AC
Oliveira
Alexandre Leite
AL
de Souza
de Alexandre
A
Souza
Geraldine
G
Madalosso
Paula R Marques da
PR
Silva
R
R
Dauar
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D014057:Tomography, X-Ray Computed; D016862:Tuberculoma, Intracranial / Q000175:diagnosis* / Q000188:drug therapy
D000995:Antitubercular Agents