HIV-INFECTION, TUBERCULOUS HEPATOSPLENIC ABSCESSES AND STEROID-THERAPY

Background. Tuberculosis (TB) with liver and/or spleen abscess (HSA) f ormation in HIV-positive patients is uncommon. Patients and methods. O ne hundred and thirty-seven HIV positive patients with TB were studied from January 93 to June 95. Patients with tuberculous HSA were enroll ed in the study. Diagnosis was obtained by recovery of Mycobacterium t uberculosis in clinical specimens and the presence of hypoechogenic le sions in liver and/or spleen. Results. M. tuberculosis isolates were r esistant to some of the usual drugs in 51 patients. Twenty of these pa tients had HSA (39%) and in 18 patients the antibiotic sensitivity tes ting showed resistance to isoniazid, rifampin, ethambutol, and strepto mycin. The remaining 86 patients had episodes of TB with drug-suscepti ble microorganism and only three patients had HSA (3%) (p < 0.001). Th e 23 patients with tuberculous HSA had a mean CD4+ lymphocyte count of 33 x 10(6) cells/L (2-111) and 7 had a previous episode of TB. The ab dominal echography showed hepatosplenomegaly in all cases. Abscesses w ere located at the liver in 12 patients (52%), spleen in 18 (78%) and both organs in 7 (30%). In 16 cases a corticosteroid therapy was indic ated. In the 3 patients with susceptible TB and HSA the clinical cours e was good. The 20 patients with resistant TB died. Conclusion. Abdomi nal TB in HIV-positive patients and HSA formation appears to be more c ommon in severely immunosuppressed patients, with resistant TB and its mortality rate is high. The response to therapy with antituberculous drugs is slow and sometimes the administration of corticosteroids is n ecessary for the resolution of symptoms.