Acute hemorrhagic leukoencephalitis during treatment for disseminated tuberculosis in a patient with AIDS [Case Study]
Abstract:A 45-year-old man with the acquired immune deficiency syndrome (AIDS) developed disseminated Mycobacterium tuberculosis infection and was started on isoniazid, rifampin, pyrazinamide and ethambutol. The treatment was interrupted because of side effects. On resumption of treatment he developed a rapidly progressive neurological illness characterized by left hemiparesis, right gaze preference, convulsions, coma, evidence of cerebral edema on computed tomography scan and death 9 days later. Autopsy showed the presence of miliary tuberculosis affecting the lungs, liver, spleen, lymph nodes and bone marrow. The brain showed evidence of acute hemorrhagic leukoencephalitis (AHL)—the first such case in a patient with AIDS. We speculate that treatment-induced lysis of mycobacteria with concomitant release of mycobacterial lipoproteins may have activated T-lymphocytes to cause AHL in this patient.
Document Type: Short Communication
Affiliations: 1: Medical and Laboratory Medicine Services, DVA Medical Center, Long Beach, California and the University of California, Irvine, California, USA 2: Pathology and Laboratory Medicine Services, DVA Medical Center, Long Beach, California and the University of California, Irvine, California, USA
Publication date: December 1, 1997
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