Pellegrino Daniela, Gerhardt Juliana, Porfírio Fátima M V, Santos Edgar de Bortholi, Dauar Rafi F, Oliveira Augusto C Penalva de, Vidal José E
Department of Infectious Diseases, Institute of Infectious Diseases Emilio Ribas, São Paulo, SP, Brazil.
Rev Inst Med Trop Sao Paulo. 2010 Sep-Oct;52(5):285-7. doi: 10.1590/s0036-46652010000500013.
Cerebral tuberculomas constitute a major differential diagnosis of cerebral toxoplasmosis in human immunodeficiency virus (HIV)-infected patients in developing countries. We report the case of a 34-year old woman co-infected with HIV and possible disseminated tuberculosis (hepatitis, lymphadenopathy, and pleural effusion) who presented a large and solitary intracranial mass lesion. Despite extensive diagnostic efforts, including brain, ganglionar, and liver biopsies, no definitive diagnosis was reached. However, a trial with first-line antituberculous drugs led to a significant clinical and radiological improvement. Atypical presentations of cerebral tuberculomas should always be considered in the differential diagnosis of intracranial mass lesions in HIV-infected patients and a trial with antituberculous drugs is a valuable strategy to infer the diagnosis in a subset of patients.
在发展中国家，脑结核瘤是人类免疫缺陷病毒（HIV）感染患者脑弓形虫病的主要鉴别诊断之一。我们报告了一例34岁女性病例，该患者合并感染HIV且可能患有播散性结核病（肝炎、淋巴结病和胸腔积液），出现了一个巨大的孤立性颅内肿块病变。尽管进行了广泛的诊断工作，包括脑活检、淋巴结活检和肝活检，但仍未得出明确诊断。然而，一线抗结核药物试验导致了显著的临床和影像学改善。在HIV感染患者颅内肿块病变的鉴别诊断中，应始终考虑脑结核瘤的非典型表现，抗结核药物试验是推断部分患者诊断的有价值策略。
