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Central Nervous System Tuberculosis with the Acquired Immunodeficiency Syndrome and Its Related Complex

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Presented in part May 1986 at the Annual Scientific Meeting of the American Thoracic Society, Kansas City, Missouri.

▸Requests for reprints should be addressed to Rajendra Kapila, M.D.; Infectious Diseases Division, University Hospital, 100 Bergen Street; Newark, NJ 07103.

Newark, New Jersey

© 1986 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1986;105(2):210-213. doi:10.7326/0003-4819-105-2-210
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Central nervous system tuberculosis occurred in three patients with the acquired immunodeficiency syndrome (AIDS) and seven patients with AIDS-related complex who were evaluated for 48 months. Nine patients were intravenous drug abusers and one was Haitian. Five patients had cerebral-ring-enhancing lesions and three had hypodense areas. The clinical spectrum included meningitis in two patients, multiple cerebral abscesses in one, and tuberculomas in four. All Mycobacterium tuberculosis isolates were sensitive to standard antituberculous drugs. All patients received treatment with isoniazid, rifampin, and pyrazinamide; six patients also received streptomycin. Three patients with AIDS died of opportunistic infection preceded by central nervous system tuberculosis. Among the patients with the AIDS-related complex, three improved with treatment, three were lost to follow-up, and one died. Tuberculosis should be considered in the differential diagnosis of central nervous system mass lesions in intravenous drug abusers with AIDS or AIDS-related complex. Because patients with tuberculosis can be cured, biopsy of accessible brain mass lesions should be mandatory. Preventive therapy may be indicated in tuberculous-infected drug abusers without disease.





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