Ring enhancing intracranial lesion responding to antituberculous treatment in an HIV-infected patient

• Published in: Revista do Instituto de Medicina Tropical de São Paulo Vol. 52; no. 5; pp. 285 - 287
• Main Authors: Pellegrino, Daniela, Gerhardt, Juliana, Porfírio, Fátima M V, Santos, Edgar de Bortholi, Dauar, Rafi F, Oliveira, Augusto C Penalva de, Vidal, José E
• Format: Journal Article
• Language: English; Portuguese
• Published: Brazil Instituto de Medicina Tropical de Sao Paulo 01.09.2010; Instituto de Medicina Tropical
• Subjects: Adult; AIDS-Related Opportunistic Infections - drug therapy; Antitubercular Agents - therapeutic use; Female; Humans; Magnetic Resonance Imaging; Tomography, X-Ray Computed; TROPICAL MEDICINE; Tuberculoma, Intracranial - drug therapy; Cerebral tuberculoma; Tuberculosis; HIV; Central nervous system
• ISSN: 0036-4665; 1678-9946; 1678-9946; 0036-4665
• DOI: 10.1590/S0036-46652010000500013

Cerebral tuberculomas constitute a major differential diagnosis of cerebral toxoplasmosis in human immunodeficiency virus (HIV)-infected patients in developing countries. We report the case of a 34-year old woman co-infected with HIV and possible disseminated tuberculosis (hepatitis, lymphadenopathy, and pleural effusion) who presented a large and solitary intracranial mass lesion. Despite extensive diagnostic efforts, including brain, ganglionar, and liver biopsies, no definitive diagnosis was reached. However, a trial with first-line antituberculous drugs led to a significant clinical and radiological improvement. Atypical presentations of cerebral tuberculomas should always be considered in the differential diagnosis of intracranial mass lesions in HIV-infected patients and a trial with antituberculous drugs is a valuable strategy to infer the diagnosis in a subset of patients.