Case study regarding HIV/TB/Tuberculoma Brain.

[Guest guest]

Dear Friends,

Greetings! I am sharing a case study regarding HIV/TB/Tuberculoma

Brain. Need your suggestions.

CASE STUDY:

52 yrs old Mr.Mxxx known PLHA for 1 ½ yrs, diagnosed as HIV positive

on 14.1.2007. Seaman by profession was on OI prophylaxis since Jan

07.

• Very irregular in his review due to his profession

• CD4 was 373 on 18.1.2007 and viral load 338464 0n 27.11.07

• Early November 2007 he came with complaints on severe head ache,

Vomiting, fever, intermittence high grad associated will chills and

rigor for 1 month duration.

• His CD4 was 189, he had Mx positive, he was started on ATT (CAT-1,

Daily regimen) along with ART(Duovir Effaverance)

• CT Scan & amp; MRI findings suggested Tuberculoma Brain, LP finding

was also favoring TB.

• After starting treatment he became worse and readmitted with right

sided Hemiparesis on 31.12.2007

• CT & amp; MRI was repeated

• The lesion was increasing in size and producing mass effect and the

radiology gave the D.Ds as ?Tuberculoma Brain ?Toxoplasmosis

• LP findings were favoring Anti TB antibody and Toxoplasmosis

antibodies were raised.

• Along with ART & amp; ATT treatment for Toxoplasmosis also initiated.

• Inspite of continuous treatment for more than 2 months the mass

increase in size

• Again viral load & amp; CD4 counts were repeated.

• CD4 was 70 and as viral load was less than 1000 ART drug resistance

study could not be performed at YRG Care.

• Patient is deteriorating, patients relatives are not willing for

surgical intervention till today and they have not given written

consent.

The case is for discussion ; salient CT, MRI and blood reports were

attached.

Personal Data

Name : MR.Mxxxxx

Age : 52/Male

Marital Status : Married

Couple Status : Concordant

Occupation : Seaman

Diagnosis

I. Related to HIV

1. HIV : HIV-1 Reactive (conformed by

western blot test)on 14.01.2007

2. CD4 :

• 373 on 18.1.2007

• 189 on 22.11.2007

• 70 on 15.2.2008

• 154 on 14.3.2008

3. Viral load :

• 338464 0n 27.11.07

II Electro Cardio Gram

1. 8.11.07 - Normal

III. CT SCAN

My Address

Dr.R.Anburajan BSc, MBBS, DMLS, FHM,

Director,

Peace Health Centre,

South Bye pass road,

Near New Bus stand,

Tirunelveli,

Tamilnadu.

Ph:0462-2552137,2552138

e-mail: anburajandoctor@...