Patient Cases -  AIDS complicated tuberculosis meningitis.

Case history and clinical manifestations

It is a case of AIDS definitely diagnosed by CDC, a female aged 37 years, who had history of paid blood donation in the year of 1995. She had history of pulmonary tuberculosis and symptoms of headache, nausea, vomiting, cervical rigidity and unclear consciousness in May, 2003. CD4 count was 84 cells/µl.

Imaging demonstrations

Fig. 2-6-2 A,B,C,D  Contrast-enhanced axial CT scanning demonstrating obvious abnormal enhancement of cerebral falx, lateral fissure cistern and cisterna ambiens, no enhancement of bilateral basal ganglia in low density.

Diagnosis

AIDS complicated tuberculosis meningitis.

Discussion

Meningitis more frequently occurs in patients with AIDS complicated central nervous system infections, with involvements of cerebral pia mater, arachnoid and its adjacent cerebrospinal fluid. Its diagnosis is mainly based on the clinic data. But the negative findings by imaging examinations cannot exclude the possible occurrence of meningitis. The common pathogenic bacteria are cryptococcus, tuberculosis bacteria, pneumonia streptococcus, fungi and non-specific granuloma. For this case, the patients has suffered from pulmonary tuberculosis with secondary intracephalic infections, leading to tuberculosis meningitis with imaging demonstrations of meninges abnormal enhancement by contrast-enhanced imaging. Tuberculosis memingitis is characterized by basal cistern lesions and it should be differentiated from Cryptococcus meningitis that has no abnormal demonstrations by plain imaging and linear enhancement of meninges by contrast-enhanced imaging. The final differential diagnosis can be made by findings of tuberculosis bacteria or Cryptococcus.