NODAL RADIOTHERAPY IN REFRACTORY TUBERCULOSIS IN AN AIDS PATIENT

A 25-year-old female with transfusion-associated acquired immunodefici ency syndrome (AIDS) treated with zidovudine (AZT) developed cervical lymph node enlargement, The histological study disclosed granulomas an d the culture revealed M. tuberculosis, The patient was treated with i soniazid, rifampicin and pirazynamide and the lymphadenomegaly resolve d, Five years later, with a CD4 cell count of 245, the lymph node enla rgement reappeared, the biopsy and special studies confirming tubercul osis (TB), She was then given ciprofloxacin, azithromycin, ethambutol, amikacin and pirazynamide without success, In two instances the enlar ged nodes were surgically removed, Facing progressive obstruction of b oth the airway and the esophagus, localized radiotherapy (1800 cGy in nine fractions) to the right aspect of the neck was delivered with dra matic resolution of the node enlargement; however, dissemination of th e infection leading to a severe lung infiltration and respiratory fail ure ended the life of the patient.