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.
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: Mohammad Wasay; Bhojo A Kheleani; Mahesh K Moolani; Jazia Zaheer; Margaret Pui; Sheema Hasan; Suhail Muzaffar; Rohit Bakshi; Arif R Sarawari Journal: J Neuroimaging Date: 2003-07 Impact factor: 2.486
Authors: Graeme Meintjes; Stephen D Lawn; Fabio Scano; Gary Maartens; Martyn A French; William Worodria; Julian H Elliott; David Murdoch; Robert J Wilkinson; Catherine Seyler; Laurence John; Maarten Schim van der Loeff; Peter Reiss; Lut Lynen; Edward N Janoff; Charles Gilks; Robert Colebunders Journal: Lancet Infect Dis Date: 2008-08 Impact factor: 25.071
Authors: Christie M Lincoln; Peter Fata; Susan Sotardi; Michael Pohlen; Tomas Uribe; Jacqueline A Bello Journal: Br J Radiol Date: 2017-11-03 Impact factor: 3.039
Authors: Suzaan Marais; Graeme Meintjes; Dominique J Pepper; Lori E Dodd; Charlotte Schutz; Zahiera Ismail; Katalin A Wilkinson; Robert J Wilkinson Journal: Clin Infect Dis Date: 2012-10-24 Impact factor: 9.079