title: Challenges of diagnosis and management of tuberculosis and HIV coinfection in resource-limited settings: a case report from Lima, Peru.
abstract: We present a Peruvian human immunodeficiency virus (HIV)-positive patient receiving first-line therapy for tuberculosis who presents with neurological complications to highlight some of the major issues in the diagnosis and management of human immunodeficiency virus-related central nervous system complications in resource-poor settings. These include limited options for diagnosing extrapulmonary and drug-resistant tuberculosis; the importance of central nervous system . imaging; and the management conundrum when faced with a broad differential diagnosis. This patient was with drug-resistant tuberculosis of the brain, unmasked by immunologic recovery in the setting of recent initiation of antiretroviral treatment. We argue that aggressive and timely empiric multidrug-resistant tuberculosis treatment is important in cases where drug-resistant tuberculosis is suspected. Knowledge gaps include a limited understanding of immune reconstitution and the optimal timing of antiretroviral treatment in the setting of drug-resistant tuberculosis.
authors.affiliation: Hospital Nacional Hipólito Unanue, Lima, Perú.
authors.forename: Christian
authors.initials: C
authors.lastname: Rojas
authors.forename: Lely
authors.initials: L
authors.lastname: Solari
authors.forename: Cesar
authors.initials: C
authors.lastname: Herrera
authors.forename: Eduardo
authors.initials: E
authors.lastname: Sanchez
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Young
authors.forename: Cesar
authors.initials: C
authors.lastname: Bonilla
authors.forename: Rocio
authors.initials: R
authors.lastname: Hurtado
authors.forename: Maribel
authors.initials: M
authors.lastname: Muñoz
authors.forename: Jhon
authors.initials: J
authors.lastname: Zeladita
authors.forename: Betty
authors.initials: B
authors.lastname: Espiritu
authors.forename: Sonya
authors.initials: S
authors.lastname: Shin
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D001927:Brain Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome; D008279:Magnetic Resonance Imaging; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D010568:Peru; D011203:Poverty; D014057:Tomography, X-Ray Computed; D020306:Tuberculosis, Central Nervous System / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D014382:Tuberculosis, Cutaneous / Q000150:complications / Q000175:diagnosis / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D014504:Urban Health
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents