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Challenges of Diagnosis and Management of Tuberculosis and HIV Coinfection in Resource-Limited Settings: A Case Report from Lima, Peru

Hospital Nacional Hipólito Unanue, Lima, Perú

Lely Solari, MD

Hospital Nacional Hipólito Unanue, Lima, Perú

Cesar Herrera, MD

Peruvian TB Program, Ministerio de Salud, Lima Perú

Eduardo Sanchez, MD

Hospital Nacional Hipólito Unanue, Lima, Perú

Geoffrey Young, MD

Brigham and Women's Hospital Boston, Massachusetts

Cesar Bonilla, MD

Peruvian TB Program, Ministerio de Salud, Lima Perú

Rocio Hurtado, MD

Massachusetts General Hospital, Boston, Massachusetts

Maribel Muñoz, RN

Socios En Salud Sucursal Perú, Lima, Perú

Jhon Zeladita, RN

Socios En Salud Sucursal Perú, Lima, Perú

Betty Espiritu, RN

Socios En Salud Sucursal Perú, Lima, Perú

Sonya Shin, MD, MPH

Division of Global Health Equity, sshin{at}partners.org

We present a Peruvian human immunodeficiency virus (HIV)-positive patient receiving first-line therapy for tuberculosis who presents with neurological complications to highlight some of the major issues in the diagnosis and management of human immunodeficiency virus—related central nervous system complications in resource-poor settings. These include limited options for diagnosing extrapulmonary and drug-resistant tuberculosis; the importance of central nervous system . imaging; and the management conundrum when faced with a broad differential diagnosis. This patient waswith drug-resistant tuberculosis of the brain, unmasked by immunologic recovery in the setting of recent initiation of antiretroviral treatment. We argue that aggressive and timely empiric multidrug-resistant tuberculosis treatment is important in cases where drug-resistant tuberculosis is suspected. Knowledge gaps include a limited understanding of immune reconstitution and the optimal timing of antiretroviral treatment in the setting of drug-resistant tuberculosis.

Key Words: HIV • tuberculosis • drug-resistant tuberculosis or MDR—TB • immune reconstitution syndrome (IRS) • resource-poor setting

This version was published on September 1, 2008

Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 7, No. 5, 232-237 (2008)
DOI: 10.1177/1545109708325468


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