Abstract
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. This disease is the second leading cause of infectious mortality in the world after infection with the human immunodeficiency virus. We report a case of multifocal tuberculosis with neuromuscular and ocular localization in an HIV-1 immunosuppressed patient in clinical and virological failure following therapeutic discontinuation due to non-compliance. This is a 43-year-old immunocompromised HIV1 patient with a history of cerebral toxoplasmosis in 2016 who consulted for right hemiplegia. These symptoms would go back to about 3 days marked by a deficit of progressive installation of the right hemicorps preceded by diffuse headaches, of moderate intensity without triggering factor radiating to the eyes associated with an intermittent fever with periods of spontaneous remissions, night sweats and chills, non-selective anorexia, non-increasing physical asthenia and unquantified weight loss. Management was 8-month antituberculous treatment, combining the first two months isoniazid (INH), rifampicin (RMP), pyrazinamide (PZN) and ethambutol (EMB), then the next 6 months (INH) and rifampicin (RMP). The reintroduction of the same antiretroviral protocol and a reinforcement of the therapeutic education made it possible to observe a decrease of the viral load. Treatment of ocular involvement was instituted with Timosol 1 drop in the eyes morning and evening and Diclocid 1 mg/ml: 1 drop in the eyes in the morning.
Highlights
Tuberculosis is an infectious disease caused by a mycobacterium of the Mycobacterium tuberculosis complex
In rare cases, the infectious process is linked to hematogenous spread of Mycobacterium tuberculosis (MT) via the choroidal vessels, often associated with a pulmonary miliary chart
We have described the case of a patient diagnosed with tuberculous uveitis during neuromenic tuberculosis/HIV1, a treatment failure
Summary
Tuberculosis is an infectious disease caused by a mycobacterium of the Mycobacterium tuberculosis complex This disease is the second leading cause of infectious mortality in the world after infection with the human immunodeficiency virus [1]. Mycobacterium tuberculosis (MT) can affect all structures of the eye without any pathognomonic presentation. Ocular involvement is present in two-thirds of cases [3] [4]. In France, the prevalence of ocular involvement during HIV is 67% [6]; in the United States 60% [7]. In Togo, the prevalence of ocular involvement is 60.5% [9]; in the DRC 64.4% [3]; Rwanda 55% [3]; in Senegal 52.23% [7]. The clinical manifestations of this infection are polymorphic and variable which makes diagnosis difficult
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