Pinzon Rizaldy Taslim, Wijaya Vincent Ongko, Paramitha Dessy
Duta Wacana Christian University School of Medicine, Yogyakarta, Indonesia.
Bethesda Hospital, Yogyakarta, Indonesia.
J Clin Tuberc Other Mycobact Dis. 2021 Mar 19;23:100230. doi: 10.1016/j.jctube.2021.100230. eCollection 2021 May.
Miliary tuberculosis (TB) is a form of extrapulmonary tuberculosis due to hematogenous dissemination and occurs more frequently in immunocompromised patients. Clinical manifestations are non-specific and varied with the related organ, including central nervous system involvement. We report the first case of encephalitis associated with miliary TB in human immunodeficiency virus (HIV)-the infected patient.
A 39-year-old male presented with severe headache, numbness in the left side of the body, and partial seizure for two weeks. Previously, the patient complaining of several weeks of cough with generalized weakness. Physical examination showed progressive left-sided weakness and numbness. Chest radiograph showed uniform-sized small nodules randomly distributed diffusely throughout the lungs. Plain computer tomography (CT) brain imaging showed hypodensity in the right parietal region. Laboratory findings showed positive for the HIV antibody test, CD4 counts were 84 cells/μL and acid-fast bacilli from sputum. He was administered empirical anti-TB treatment and was discharged without any complications on day 10.
This is a rare cause of encephalitis due to miliary TB infection in HIV patients. Even though central nervous system involvement is rare in miliary TB infection, physicians should be aware of atypical features of the disease and comorbidity that may predispose this infection.
粟粒性肺结核是血行播散所致的一种肺外结核形式，在免疫功能低下患者中更为常见。其临床表现无特异性，因受累器官而异，包括中枢神经系统受累。我们报告了首例人类免疫缺陷病毒（HIV）感染患者中与粟粒性肺结核相关的脑炎病例。
一名39岁男性出现严重头痛、身体左侧麻木及部分性癫痫发作两周。此前，该患者主诉咳嗽数周伴全身乏力。体格检查显示左侧进行性无力和麻木。胸部X线片显示大小均匀的小结节随机弥漫分布于双肺。脑部普通计算机断层扫描（CT）成像显示右侧顶叶区域低密度影。实验室检查结果显示HIV抗体检测呈阳性，CD4细胞计数为84个/μL，痰涂片抗酸杆菌阳性。给予经验性抗结核治疗，第10天无任何并发症出院。
这是HIV患者中粟粒性结核感染导致脑炎的罕见病因。尽管粟粒性结核感染累及中枢神经系统罕见，但医生应了解该疾病的非典型特征及可能易患此感染的合并症。
