Acute myelopathy or cauda equina syndrome in HIV-positive adults in a tuberculosis endemic setting: MRI, clinical, and pathologic findings.
OBJECTIVE
Cape Town is the center of an HIV-tuberculosis coepidemic. This study's aim was to highlight the importance and to describe the MR imaging features of tuberculosis in acute myelopathy and cauda equina syndrome in HIV-positive adults. To accomplish this we retrospectively reviewed the MR imaging and clinico-pathologic findings of HIV-positive patients presenting to our hospital with recent onset paraplegia and sphincter dysfunction over a 4-year period, 2008-2011.


METHODS
MR imaging, CD4 count, and CSF analysis and pathology were correlated in 216 cases.


RESULTS
Fifty-eight percent (127) of subjects were female. The mean age was 37 years. The median CD4 count was 185 cells/μL. Twenty-five percent (54) of patients were on antiretroviral therapy. MR imaging showed spondylitis in 30% (65). The median CD4 count in these patients was significantly higher than in the remainder. Disk destruction was common and 10% had synchronous spondylitis elsewhere in the spinal column. Thirty percent (64) had features of myelitis/arachnoiditis. Twenty-five percent (55) had no MR imaging abnormality. In 123 (57%) of cases with a definitive etiology on CSF culture or biopsy, 84 (68%) were attributable to tuberculosis including all spondylitis cases and 40% of nonspondylitis cases. Twelve (10%) were due to nontuberculous infection and 12 (10%) had HIV-associated tumors including 2 rare Epstein-Barr-related tumors.


CONCLUSIONS
In our setting, acute onset myelopathy/cauda equina syndrome in HIV-positive patients is largely attributable to tuberculosis with nonspondylitic forms being more common than spondylitis and associated with a lower CD4 count.
From the Department of Radiology (S.C., G.C.), Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
S
S
Candy
From the Department of Radiology (S.C., G.C.), Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
G
G
Chang
Department of Radiology (S.A.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
S
S
Andronikou
D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011128:Polyradiculopathy / Q000209:etiology* / Q000473:pathology; D012189:Retrospective Studies; D013019:South Africa; D013118:Spinal Cord Diseases / Q000209:etiology* / Q000473:pathology; D014376:Tuberculosis / Q000150:complications*