INTRACEREBRAL TUBERCULOMAS IN HIV-INFECTED PATIENTS - EPIDEMIOLOGY AND MAGNETIC-RESONANCE-IMAGING

Intracerebral tuberculomas, observed in two HIV-infected patients, ill ustrated the diagnostic and therapeutic problems involved when an intr acranial formation is discovered in this clinical situation. Both pati ents had a history of pulmonary tuberculosis. No preventive treatment had been given and disseminated tuberculosis occurred within a short d elay (less than 2 years). A neurological deficiency led to the discove ry of intracranial formations. The lack of effect of anti-toxoplasmosi s therapy and the simultaneous discovery of tuberculous lesions strong ly suggested intracerebral tuberculoma. With antituberculosis treatmen t, the general signs disappeared rapidly. Magnetic resonance imaging w as particularly useful for following the course of the intracerebral l esions with a stereotype structure (confluent polylobular abscesses), for eliminating rapid evolution which would suggest lymphoma, the main differential diagnosis and to indicate corticosteroid treatment due t o persistant oedema. Outcome was favourable with anti-tuberculosis the rapy and corticosteroids. Intracerebral tuberculomas are rare and shou ld be entertained in patients with tuberculosis when intracerebral abs cesses do not respond to antitoxoplasmosis therapy. Magnetic resonance imaging is the most adapted imaging technique for diagnosis and follo w-up.