Abstract
Tuberculosis (TB) and cryptococcal meningitis remain the commonest causes of meningitis in patients with advanced HIV. This is a case history of an HIV patient on antiretroviral therapy (ART) for 2 months presented with CNS symptoms suggesting possible IRIS for an intra cerebral infection or any other CNS lesion. However, in diagnostic work-up patient is found to have features for tuberculosis as well as cryptococcal meningeal infection making a diagnostic dilemma of the reason for the IRIS
Highlights
Tuberculosis and Cryptococcal meningitis are the most common causes of opportunistic meningitis in HIV infected patients and share similar clinical and laboratory features resulting in delays to diagnosis and poorer outcomes (J E Vidal, E J F Peixoto de Miranda, J Gerhardt, M Croda, & D R Boulware, 2017)
Tuberculosis remains the leading cause of death among people living with HIV, causing one in every third AIDS related deaths (AIDS, 2019, pp. 2-4)
The term immune reconstitution inflammatory syndrome (IRIS) has been used to describe a group of clinical syndromes associated with immune reconstitution that is observed commonly for mycobacterial infection, and for other opportunistic infections (OIs), including Pneumocystis jirovecii pneumonia (PCP), toxoplasmosis, hepatitis B and hepatitis C infections, cytomegalovirus (CMV) infection, varicella-zoster virus (VZV) infection and cryptococcal infection (Navs E, 2002)
Summary
Tuberculosis and Cryptococcal meningitis are the most common causes of opportunistic meningitis in HIV infected patients and share similar clinical and laboratory features resulting in delays to diagnosis and poorer outcomes (J E Vidal, E J F Peixoto de Miranda, J Gerhardt, M Croda, & D R Boulware, 2017). Cryptococcal antigen and India ink stain was positive in cerebrospinal-fluid, with negative TB PCR, TB culture. Since the presence of lesions suggestive of tuberculomas in MRI and high protein count and low sugar level in CSF analysis, the diagnosis of CNS TB was made and antituberculosis treatment (ATT) was started with steroid cover, though there were no microbiological evidence.
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