PMID- 27302013
OWN - NLM
STAT- MEDLINE
DCOM- 20161213
LR  - 20240324
IS  - 1941-5923 (Electronic)
IS  - 1941-5923 (Linking)
VI  - 17
DP  - 2016 Jun 15
TI  - A Patient Presenting with Tuberculous Encephalopathy and Human Immunodeficiency 
      Virus Infection.
PG  - 406-11
AB  - BACKGROUND: In the USA, Mycobacterium tuberculosis infection is more likely to be 
      found in foreign-born individuals, and those co-infected with human 
      immunodeficiency virus (HIV) are more likely to have tuberculous meningitis. The 
      literature is lacking in details about the clinical workup of patients presenting 
      with tuberculous meningitis with encephalopathic features who are co-infected 
      with HIV. This report demonstrates a clinical approach to diagnosis and 
      management of tuberculous meningitis. CASE REPORT: A 33-year-old Ecuadorean man 
      presented with altered consciousness and constitutional symptoms. During the 
      workup he was found to have tuberculous meningitis with encephalopathic features 
      and concurrent HIV infection. Early evidence for tuberculosis meningitis included 
      lymphocytic pleocytosis and a positive interferon gamma release assay. A 
      confirmatory diagnosis of systemic infection was made based on lymph node biopsy. 
      Imaging studies of the neck showed scrofula and adenopathy, and brain imaging 
      showed infarctions, exudates, and communicating hydrocephalus. Treatment was 
      started for tuberculous meningitis, while anti-retroviral therapy for HIV was 
      started 5 days later in combination with prednisone, given the risk of immune 
      reconstitution inflammatory syndrome (IRIS). CONCLUSIONS: A clinical picture 
      consistent with tuberculous meningitis includes constitutional symptoms, foreign 
      birth, lymphocytic pleocytosis, specific radiographic findings, and 
      immunodeficiency. Workup for tuberculous meningitis should include MRI, HIV 
      screening, and cerebral spinal fluid analysis. It is essential to treat 
      co-infection with HIV and to assess for IRIS.
FAU - Li, Jason
AU  - Li J
AD  - Department of Family Medicine, Brown University Family Medicine, Pawtucket, RI, 
      USA.
FAU - Afroz, Suraiya
AU  - Afroz S
AD  - Medicine Department, Mount Sinai St.Luke's, 1111 Amsterdam Ave, USA.
FAU - French, Eric
AU  - French E
AD  - Department of Psychiatry, Palm Beach Centre for Graduate Medical Education, West 
      Palm Beach, FL, USA.
FAU - Mehta, Anuj
AU  - Mehta A
AD  - Department of Medicine, Nyack Hospital, Nyack, NY, USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20160615
PL  - United States
TA  - Am J Case Rep
JT  - The American journal of case reports
JID - 101489566
SB  - IM
MH  - AIDS-Related Opportunistic Infections/diagnosis
MH  - Adult
MH  - HIV Infections/*complications
MH  - Humans
MH  - Male
MH  - Tuberculosis, Meningeal/complications/*diagnosis
PMC - PMC4917069
EDAT- 2016/06/16 06:00
MHDA- 2016/12/15 06:00
PMCR- 2016/06/15
CRDT- 2016/06/16 06:00
PHST- 2016/06/16 06:00 [entrez]
PHST- 2016/06/16 06:00 [pubmed]
PHST- 2016/12/15 06:00 [medline]
PHST- 2016/06/15 00:00 [pmc-release]
AID - 897745 [pii]
AID - 10.12659/ajcr.897745 [doi]
PST - epublish
SO  - Am J Case Rep. 2016 Jun 15;17:406-11. doi: 10.12659/ajcr.897745.