Successful Treatment of Cerebral Tuberculoma in Acquired Immune Deficiency Syndrome Patient a Case Report
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Abstract
Introduction: Tuberculosis (TB) remains a leading problem in developing and endemic countries. Cerebral tuberculosis is a rare but dangerous complication of tuberculosis infection in the central nervous system. The immunosuppressive condition in human immunodeficiency virus infection is a risk factor for severe tuberculosis.
Case Report: An Indonesian man, 32 years old, married, came with complaints of headaches, dizziness, delirium, nausea and vomiting since 1 month before the examination. He had a history of TB treatment 1 year before the examination. The results of the neurological examination were within normal limits, the HIV test was reactive and there was a decrease in CD4. Head MRI examination with contrast showed multiple solid nodules in the thalamus with the largest size 2.3×2.7 cm, indicating cerebral tuberculoma. Chest x-ray was normal, GeneXpert MTB sputum was not detected. Next, primary treatment is given with anti-tuberculosis drugs, Highly Active Antiretroviral Therapy (HAART), co-trimoxazole, and dexamethasone. There was clinical, laboratory and radiological improvement after 12 months of treatment. Viral load is undetectable, CD4 is elevated. A head CT scan did not show tuberculoma. He became healthy and was able to return to work
Discussion: Cerebral tuberculoma is a condition characterized by the presence of intracranial tuberculoma. The clinical manifestations are non-specific, such as headaches or seizures. This is caused by space occupying lesions and increase intracranial pressure. In this case, the diagnosis of cerebral tuberculoma was made through head MRI with contrast. TB therapy and co-trimoxazole are given as soon as the diagnosis is made, while antiretrovirals are given 2 weeks after he has tolerated the TB medication. The minimum duration of therapy for cerebral tuberculosis is 12 months. He require lifelong antiretroviral medication.
Conclusion: Tuberculoma should be considered as differential diagnosis of space-occupying lesions in patients HIV/AIDS. Early diagnosis, adequate therapy, patient adherence and family support can cure severe tuberculosis.
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References
I. Ajmala, I. E., & Wulandari, L. 2015. Terapi ARV pada Penderita Ko-Infeksi TB-HIV. Jurnal respirasi, 1(1), 22-28.
II. Ashok Kumar, Srirangam Ramya, Sai Mounika Neelamraju. 2022. A study of clinical profile and treatment outcomes in CNS tuberculoma. IAIM. 9(9): 21-29
III. Bovijn, L., Solomons, R., & Marais, S. 2019. Neurological TB in HIV. HIV and Tuberculosis: A Formidable Alliance, 295-334.
IV. Cahyati, W. H. 2019. Determinan Kejadian Tuberkulosis pada Orang dengan HIV/AIDS. HIGEIA (Journal of Public Health Research and Development), 3(2), 168-178.
V. Gebresillassie B. M., Gebeyehu M. B., Abegaz T. M., Erku D. A., Mekuria A. B., Tadesse Y. D., et al. 2016. Evaluation of cotrimoxazole use as a preventive therapy among patients living with HIV/AIDS in Gondar University Referral Hospital, northwestern Ethiopia: a retrospective cross-sectional study. HIV AIDS 8:125.
VI. Hendyatama, T. H., & Hadi, U. 2022. Successful Treatment of Cerebral Tuberculoma and Tuberculous Lymphadenitis in an HIV/AIDS Patient: A Case Report. Indian Journal of Forensic Medicine & Toxicology. 16(1), 1173-1180
VII. Ibrahim, I. G., Osman, A. A., Shikhow, M. G., Celik, C., Mutlu, E., & Tahtabaşı, M. 2022. Magnetic resonance imaging findings of intracranial tuberculoma patients in a tertiary hospital in Mogadishu, Somalia: a retrospective study. Annals of Medicine and Surgery, 78, 103812.
VIII. Ikbal, M., & Sugianto, P. 2021. Perbaikan Klinis dan Radiologis Tuberkuloma Serebral dengan Terapi Non Operatif: Dua Laporan Kasus. AKSONA, 1(1), 18-23.
IX. Kartasasmita, C. B. 2016. Epidemiologi tuberkulosis. Sari Pediatri. 11(2), 124-9.
X. Keene, C. M., Griesel, R., Zhao, Y., Gcwabe, Z., Sayed, K., Hill, A., ... & Meintjes, G. (2021). Virologic efficacy of tenofovir, lamivudine and dolutegravir as second-line antiretroviral therapy in adults failing a tenofovir-based first-line regimen: A prospective cohort study. AIDS (London, England), 35(9), 1423.
XI. Khusnurrokhman, G., & Kusmiati, T. 2020. Cerebellar tuberculoma in a patient with lung tuberculosis new case: a case report. J. Respir, 6(3), 75-78.
XII. Kumar EA, Bai PJ. 2016. A clinical study of CNS tuberculomas. IAIM. 3(6):101-106
XIII. MADI, D., Achappa, B., Rao, S., Adhikari, P., & Mahalingam, S. 2012. Cerebral Toxoplasmosis Mimicking Intracranial Tuberculoma. Journal of Clinical & Diagnostic Research, 6(6).
XIV. Marais, S., Roos, I., Mitha, A., Patel, V., Kalincik, T., & Bhigjee, A. I. 2020. Presentation and outcome of patients with intracranial tuberculoma in a high HIV prevalence setting. The International Journal of Tuberculosis and Lung Disease. 24(2), 224-232.
XV. Permatasari, J., Meirista, I., & Bafadhal, H. (2021). Hubungan Kombinasi Antiretroviral Terhadap Kadar CD4 Pasien HIV TB Rawat Jalan RSUD H. Abdul Manap Jambi. Journal of Pharmacy and Science, 6(2).
XVI. Priyadarshi, M., Arora, U., & Jorwal, P. 2021. Toxoplasmosis and tuberculosis: brain lesions in HIV/AIDS differentiated by response to therapy. BMJ Case Reports, 14(5).
XVII. Purnamasari, D. 2022. Laporan kasus toksoplasmosis serebri pada infeksi human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Intisari Sains Medis, 13(1), 371-376.
XVIII. Scott, L. J. (2020). Dolutegravir/lamivudine single-tablet regimen: a review in HIV-1 infection. Drugs, 80(1), 61-72.
XIX. Tancredi, M. V., Sakabe, S., & Waldman, E. A. (2022). Mortality and survival of tuberculosis coinfected patients living with AIDS in São Paulo, Brazil: a 12-year cohort study. BMC Infectious Diseases, 22(1), 223.
XX. Vidal, J. E., Hernández, A. V., Oliveira, A. C., Souza, A. D. L., Madalosso, G., Silva, P. R., & Dauar, R. 2004. Cerebral tuberculomas in AIDS patients: a forgotten diagnosis?. Arquivos de neuro-psiquiatria, 62, 793-796.
XXI. WHO. 2014. Guidelines on Post-exposure Prophylaxis for HIV and the Use of Co-Trimoxazole Prophylaxis for HIV-Related Infections Among Adults, Adolescents and Children: Recommendations for a Public Health Approach: December 2014 Supplement to the 2013 Consolidated Guidelines on the use of Antiretroviral Drugs for Treating and Preventing HIV Infection. Geneva: World Health Organization
XXII. Wijaya, V. O., Ardianto, D., Pratiwi, G. S. S., Mahendra, A., Shintyalola, G. W., & Asany, R. I. 2020. Tuberkuloma Serebral Pada Penderita Acquired Immune Deficiency Syndrome. Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia, 37(3).
XXIII. Winarno, A. N. S. 2018. Multiple Intracranial Tuberculomas: A Rare Case of CNS TB. JKKI: Jurnal Kedokteran dan Kesehatan Indonesia, 53-59.
XXIV. Wong-Achi, X., Vallejo, L. U., & Chuchuca, A. V. (2022). Basal ganglia tuberculoma mimicking a brain tumor: Minimally invasive resection using tubular retractor system. Interdisciplinary Neurosurgery, 28, 101512.
XXV. Yogi, P., Andrika, I. P., Sajinadiyasa, I. G. K., & Bagiada, I. M. 2021. Diagnosis dan penatalaksanaan tuberkulosis sistem saraf pusat. Intisari Sains Medis. 12(3), 912-916.