Neuroradiological features of the tuberculosis-associated immune reconstitution inflammatory syndrome.

Abstract

SETTING:

Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an important complication in human immunodeficiency virus type I (HIV-1) infected tuberculosis (TB) patients who start combination antiretroviral treatment (ART). Neurological manifestations occur in more than 10% of TB-IRIS cases. Apart from a few case reports, the radiological features of neurological TB-IRIS have not been described.

OBJECTIVE:

To describe the neuroradiological findings of patients with paradoxical neurological TB-IRIS.

DESIGN:

Computed tomography (CT; n = 13) and magnetic resonance imaging (n = 3) findings of 16 patients were reviewed.

RESULTS:

IRIS manifestations included meningitis (n = 4), intracranial space occupying lesions (SOLs, presumed tuberculomas; n = 5), meningitis and SOLs (n = 5), radiculomyelitis (n = 1) and spondylitis (n = 1). In patients with tuberculoma IRIS, we observed a high prevalence of 1) low density lesions on non-contrast-enhanced CT (all lesions), 2) multiple lesions (in 5/10 patients) and 3) perilesional oedema (17/22 lesions). In patients with meningitis, meningeal enhancement (n = 2) and hydrocephalus (n = 1) were infrequently observed.

CONCLUSION:

This is the first substantial series to describe the radiological features of paradoxical neurological TB-IRIS. Compared to published radiological findings of tuberculomas in HIV-1-infected patients (not receiving ART), an increased inflammatory response is suggested in tuberculoma IRIS. However, this was not observed in patients with TB meningitis IRIS.

• Authors: S Marais, P Scholtz, D J Pepper, G Meintjes, R J Wilkinson, S Candy
• Journal: The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease (Int J Tuberc Lung Dis) Vol. 14 Issue 2 Pg. 188-96 (Feb 2010) ISSN: 1815-7920 [Electronic] France
• PMID: 20074410 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Antiretroviral Therapy, Highly Active (adverse effects)
• Female
• HIV Infections (complications, drug therapy)
• Humans
• Immune Reconstitution Inflammatory Syndrome (chemically induced, diagnostic imaging, physiopathology)
• Magnetic Resonance Imaging
• Male
• Retrospective Studies
• Single-Blind Method
• Tomography, X-Ray Computed
• Tuberculoma (complications)
• Tuberculosis (complications)
• Tuberculosis, Meningeal (complications)
• Young Adult