Operated case of tubercular meningitis with hydrocephalus in an immunocompromised patient and acute abdomen-management controversy: a case report

International Surgery Journal ◽

10.18203/2349-2902.isj20213680 ◽

2021 ◽

Author(s):

Amar Nath

Keyword(s):

Acute Abdomen ◽

Immunocompromised Patient ◽

Intestinal Tuberculosis ◽

Hiv Positive ◽

Tubercular Meningitis ◽

Pathological Conditions ◽

Ventriculoperitoneal Shunting ◽

Common Infectious Disease ◽

Perforation Peritonitis ◽

Ventriculo Peritoneal Shunt

Tuberculosis is a very common infectious disease in developing countries like India. Most common form includes pulmonary tuberculosis. Other common forms are tubercular meningitis and intestinal tuberculosis. Hydrocephalus is one of the commonest complications of tubercular meningitis. We present a HIV positive case who had tubercular meningitis with hydrocephalus and was operated for ventriculoperitoneal shunting, later developed intestinal tuberculosis with perforation peritonitis. The presentation of an acute abdomen with a ventriculo-peritoneal shunt requires skillful diagnostic workup and management. Apart from complications caused by the shunt, primary abdominal pathological conditions must be taken into consideration. Tuberculosis has multiple presentations all of which should be kept in mind.

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Radiological-Pathological Correlation in Plasmablastic Lymphoma in an Immunocompromised Patient

Case Reports in Ophthalmological Medicine ◽

10.1155/2018/4746050 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

A. Moramarco ◽

M. Marenco ◽

M. La Cava ◽

A. Lambiase

Keyword(s):

Drug User ◽

Fungal Infections ◽

Immunocompromised Patient ◽

Poor Response ◽

Plasmablastic Lymphoma ◽

Response To Treatment ◽

Hiv Positive ◽

Radiological Features ◽

Pathological Conditions ◽

Aggressive Form

Plasmablastic lymphoma (PBL) is a malignant, rare, and aggressive form of non-Hodgkin’s lymphoma with poor response to treatment that most commonly involves the oral mucosa of immunodeficient patients. The orbit might be primarily or secondarily involved; on the other hand other pathological conditions, i.e., fungal infections, may localize in the orbit in both immunocompromised patients and drug user, which might have similar radiological features. We describe the clinical, radiological, and pathological features of an orbital plasmablastic lymphoma (PBL) in an immunocompromised HIV positive drug user patient.

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Cerebral Hydatid Cyst in a Young Immunocompromised Patient in Parakou

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_76_18 ◽

2018 ◽

Vol 09 (04) ◽

pp. 622-624

Author(s):

Thierry Adoukonou ◽

Donald Accrombessi ◽

Mendinatou Agbetou

Keyword(s):

Immunocompromised Patient ◽

Motor Deficit ◽

Hiv Positive ◽

Neurosurgical Procedure ◽

Generalized Seizures ◽

Immunodeficiency Virus ◽

Cerebral Hydatid Cyst ◽

Initial Improvement ◽

Inflammatory Syndrome ◽

Annular Calcification

ABSTRACTWe report the case of a 30-year-old human immunodeficiency virus (HIV)-positive HIV patient who was poorly followed. She was admitted on November 30, 2017, for the management of febrile encephalitis syndrome with motor deficit of the left hemicorps and generalized seizures. In biology, we found a nonspecific inflammatory syndrome. The cerebral imaging without and with injection found a cystic formation multilobed right fronto-parietal of approximately 83 mm × 62 mm, the presence of an annular calcification of approximately 8 mm with a commitment under falcator, and a contralateral ventricle dilation. Treatment with antiepileptic, antibiotic, antiparasitic, and corticosteroid therapy was marked by death the day before the neurosurgical procedure after initial improvement.

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The Role of QuantiFERON-TB Gold Plus in Mycobacterium Tuberculosis Detection in a Severe HIV Immunocompromised Patient—Case Report

Pathogens ◽

10.3390/pathogens10111523 ◽

2021 ◽

Vol 10 (11) ◽

pp. 1523

Author(s):

Florentina Dumitrescu ◽

Cătălina-Gabriela Pisoschi ◽

Vlad Pădureanu ◽

Andreea Cristina Stoian ◽

Livia Dragonu ◽

...

Keyword(s):

Mycobacterium Tuberculosis ◽

Immunocompromised Patient ◽

Symptomatic Treatment ◽

Pneumocystis Pneumonia ◽

Hiv Positive ◽

Patient Case ◽

Mycobacterium Tuberculosis Infection ◽

Antituberculosis Therapy ◽

Antituberculosis Treatment

Tuberculosis (TB) is an important opportunistic infection in HIV-positive people. We are reporting a case of a 31-year-old HIV-infected patient who was hospitalized in July 2021 for dyspnea, cough with mucopurulent sputum and asthenia. He was confirmed to have Serratia liquefaciens pneumonia and acute respiratory failure. The evolution was unfavorable despite the antibiotic, pathogenic and symptomatic treatment. Because the patient had severe immunosuppression (CD4 count = 37 cell/mm3), we used QuantiFERON-TB Gold Plus for the detection of the Mycobacterium tuberculosis infection. The antituberculosis therapy was initiated, which resulted in a significant improvement of the general condition and the patient was discharged with the recommendation to continue antiretroviral therapy, antituberculosis treatment and Trimethoprim/Sulfamethoxazole—single tablet daily for the prophylaxis of Pneumocystis pneumonia.

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Tubercular meningitis with hydrocephalus with HIV co-infection: role of cerebrospinal fluid diversion procedures

Journal of Neurosurgery ◽

10.3171/2014.12.jns14257 ◽

2015 ◽

Vol 122 (5) ◽

pp. 1087-1095 ◽

Cited By ~ 12

Author(s):

Raman Mohan Sharma ◽

Nupur Pruthi ◽

Arivazhagan Arimappamagan ◽

Sampath Somanna ◽

Bhagavathula Indira Devi ◽

...

Keyword(s):

Hiv Positive ◽

Short Term ◽

Tubercular Meningitis ◽

Term Outcome ◽

Long Term Outcome ◽

Shunt Placement ◽

Poor Outcome ◽

Hiv Negative

OBJECT Hydrocephalus is one of the commonest complications of tubercular meningitis (TBM), and its incidence is increasing with the HIV epidemic. Literature evaluating the role of ventriculoperitoneal shunts in HIV-positive patients with TBM and their long-term prognosis is scarce. METHODS Between June 2002 and October 2012, 30 HIV-positive patients with TBM and hydrocephalus underwent ventriculoperitoneal shunt placement. Thirty age-, sex-, and grade-matched HIV-negative patients with TBM and hydrocephalus were randomly selected as the control group. Outcome was analyzed at discharge (short-term outcome) and at follow-up (long-term outcome). Univariate and multivariate analyses were performed to look for predictors of outcome; p < 0.05 was considered significant. RESULTS There were no differences in the clinical, radiological, or biochemical parameters between the 2 groups. Short-term outcome was better in the HIV-negative group (76.7% improvement) than in the HIV-positive group (70%). However, the long-term outcome in HIV-positive patients was very poor (66.7% mortality and 76.2% poor outcome) compared with HIV-negative patients (30.8% mortality and 34.6% poor outcome). Seropositivity for HIV is an independent predictor of poor outcome both in univariate and multivariate analyses (p = 0.038). However, in contrast to previous reports, of 5 patients with TBM in good Palur grades among the HIV-positive patients, 4 (80%) had good outcome following shunt placement. CONCLUSIONS The authors recommend that shunt treatment should not be performed in HIV-positive patients in poor Palur grade with hydrocephalus. A trial of external ventricular drainage should be undertaken in such patients, and shunt treatment should be performed only if there is any improvement. However, HIV-positive patients in good Palur grades should undergo VP shunt placement, as these patients have better outcomes than previously reported.

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Beware of cryptococcomas when treating Cryptococcal meningitis

Journal of Neurology & Stroke ◽

10.15406/jnsk.2020.10.00435 ◽

2020 ◽

Vol 10 (5) ◽

pp. 183-184

Author(s):

Rafael Ferreira Nascimento ◽

Diogo Raposo André, ◽

Fabiana Gouveia ◽

Nancy Faria ◽

Ana Paula Reis

Keyword(s):

Immunocompromised Patient ◽

Brain Mri ◽

Hiv Positive ◽

Rare Presentation ◽

Neck Stiffness ◽

Viral Loads ◽

Hiv Rna ◽

Neurological Exam ◽

History Of ◽

The Brain

Introduction: The authors describe a rare presentation of central nervous system cryptococcosis in an immunocompromised patient. Case description: An HIV-positive patient, with poor adherence to the treatment, presented with a seventeen days history of severe headache. On the neurological exam there was only evidence of neck stiffness, he had a CD4 count of 23 cells/μl and plasma HIV RNA viral loads of 364,000 copies/ml. Lumbar puncture revealed positive for cryptococcal antigen virus and so treatment with amphotericin B was started. During his admission the patient developed an expressive aphasia with visual hallucinations and the brain MRI revealed cerebral cryptococcomas. After 98 days of treatment general and neurological examination was normal and the patient was discharged home. Conclusion: This case highlights a rare and severe complication of Cryptococcus neoformans infection in immunocompromised patients.

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STUDY IN PAEDIATRIC AGE GROUP UNDERGOING EMERGENCY LAPAROTOMY : OBSERVATIONAL STUDY

10.36106/ijsr/6529703 ◽

2021 ◽

pp. 1-2

Author(s):

Akash KR. Gupta ◽

Manoj KR Das ◽

Marshal D Kerketta

Keyword(s):

Intestinal Obstruction ◽

Acute Abdomen ◽

Gastrointestinal Diseases ◽

Acute Intestinal Obstruction ◽

Emergency Laparotomy ◽

Age Group ◽

Common Cause ◽

Colonic Atresia ◽

Paediatric Age ◽

Perforation Peritonitis

INTRODUCTION: Acute abdomen can be defined as “syndrome included by wide variety of pathological conditions that require emergent medical or more often surgical management.” Acute abdomen is caused due to gastrointestinal diseases such as intestinal obstruction and perforation peritonitis. AIM: The aim of our study was to observe the common cause in paediatric age group undergoing emergency laprotomy in our institutions. MATERIAL AND METHODS:This prospective study included 77children aged below or equal to 15years, underwent emergency laprotomy for acute intestinal conditions between January 2019 to December 2019 in RIMS,RANCHI. We excluded neonates ,patients of jejunoileal colonic atresia and stenosis, anorectal malformation(ARM), congenital pouch colon, neonatal necrotizing enterocolitis(NEC), hirschprung’s disease, gastrointestinal tumor. RESULTS: Total of 77 laprotomies were performed in emergency in children below or equal to 15 years age,59(76.62% ) were boys and 18(23.37% )were girls with male:female ratio of 3.2:1. 36(46.75%) cases were done for acute intestinal obstruction and 41(53.24%) cases were done for perforation peritonitis.20(25.97%)emergency laprotomy was performed in the age group 1-5 years and 57(74.02% ) were performed in the age group 5-15 years. Causes in order of frequency for intestinal obstruction were intussusceptions, post operative band/adhesion, abdominal tb obstruction, meckel’s diverticulum and worm obstruction. Causes in order of frequency for perforation peritonitis were typhoid, abdominal tb, appendicular perforation and abdominal trauma. CONCLUSION: In our study maximum emergency laprotomy was performed in male patients with male:female ratio of 3.2:1. Perforation peritonitis was more common than acute intestinal obstruction. 5-15 year age group were more commonly affected. Typhoid ileal perforation was the most common cause for emergency laprotomy followed by intussusception.

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