Tobacco use as a contributing factor in HIV–TB co- infection – the multidisciplinary approach in the case of an immunosuppressed smoking patient
Abstract
Introduction
Tuberculosis-HIV co-infection remains a challenge to the clinician largely as a result of the potentiation mutual, which will result in deterioration of the immunological status and increased risk of mortality.
Case presentation
37-year-old patient, smoker 5 pack-year (5PA), without pathological history, who is hospitalized in 2021 in an ear, nose and throat otolaryngology (ENT) service in the context of the appearance of laterocervical and axillary polyadenopathy, during the examination histopathologically resulting to be of tuberculous etiology. The transfer was made to the pneumophthisiology clinic where human immunodeficiency virus (HIV) testing was performed it was positive. It was decided to initiate antituberculosis and systemic corticoid treatment with initially favorable evolution, with the association following antiretroviral therapy. The patient develops motor deficits, and the brain magnetic resonance imaging (MRI) examination revealed the presence of two left hemispheric intracranial processes biopsied by neuronavigation, the result of which revealed histopathological changes highly suggestive of granulomatosis. In dynamics, the clinical examination carried out in an infectious disease service highlights the appearance of a pseudotumoral formation, with consistent right sterno-costal fluctuation, which is why it was decided to redirect the case to the thoracic surgery department, where drainage of the formation was practiced with the microbiological detection of Mycobacterium tuberculosis.
Discussions
The peculiarity of the case resides in the presence of multiple foci of extrapulmonary tuberculosis in a case of tuberculosis-human immunodeficiency virus ( TB-HIV) co-infection, without lung damage, in a patient with apparent compliance to treatment.
Conclusions
Tuberculosis remains a challenge for the clinician, especially in the case of HIV co-infection, association with mortality and increased morbidity.
© 2024 Luiza Iorga, Mihaela Tanasescu, Gina Ciolan, Mara Balteanu, Anca Voinea, Mihnea Orghidan, Alina Croitoru, Andreea Dumitrița Slabu, published by Romanian Society of Pneumology
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