Neuroradiological features of the tuberculosis-associated immune reconstitution inflammatory syndrome.
METHODS
Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an important complication in human immunodeficiency virus type I (HIV-1) infected tuberculosis (TB) patients who start combination antiretroviral treatment (ART). Neurological manifestations occur in more than 10% of TB-IRIS cases. Apart from a few case reports, the radiological features of neurological TB-IRIS have not been described.


OBJECTIVE
To describe the neuroradiological findings of patients with paradoxical neurological TB-IRIS.


METHODS
Computed tomography (CT; n = 13) and magnetic resonance imaging (n = 3) findings of 16 patients were reviewed.


RESULTS
IRIS manifestations included meningitis (n = 4), intracranial space occupying lesions (SOLs, presumed tuberculomas; n = 5), meningitis and SOLs (n = 5), radiculomyelitis (n = 1) and spondylitis (n = 1). In patients with tuberculoma IRIS, we observed a high prevalence of 1) low density lesions on non-contrast-enhanced CT (all lesions), 2) multiple lesions (in 5/10 patients) and 3) perilesional oedema (17/22 lesions). In patients with meningitis, meningeal enhancement (n = 2) and hydrocephalus (n = 1) were infrequently observed.


CONCLUSIONS
This is the first substantial series to describe the radiological features of paradoxical neurological TB-IRIS. Compared to published radiological findings of tuberculomas in HIV-1-infected patients (not receiving ART), an increased inflammatory response is suggested in tuberculoma IRIS. However, this was not observed in patients with TB meningitis IRIS.
Marais
S
S
Department of Medicine, GF Jooste Hospital, Manenberg, South Africa. suzaanmarais@gmail.com
Scholtz
P
P
Pepper
D J
DJ
Meintjes
G
G
Wilkinson
R J
RJ
Candy
S
S
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed; D014375:Tuberculoma / Q000150:complications; D014376:Tuberculosis / Q000150:complications*; D014390:Tuberculosis, Meningeal / Q000150:complications; D055815:Young Adult