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

^* To whom correspondence should be addressed. E-mail: sshin{at}partners.org.

	Abstract

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 was diagnosed with drug-resistant tuberculosis of the skin, and we felt that his neurologic syndrome was consistent with 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.

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 was diagnosed with drug-resistant tuberculosis of the skin, and we felt that his neurologic syndrome was consistent with 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.

First published on September 23, 2008, doi:10.1177/1545109708325468

Journal of the International Association of Physicians in AIDS Care (JIAPAC) 2008;7:232.

A more recent version of this article appeared on September 1, 2008


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