RESUMO
Disseminated tuberculosis in HIV infection involves multiple organs. Pulmonary and lymph node involvement are the commonest form of tuberculosis in HIV infection [1, 2]. Other forms of tuberculosis in the absence of lung and lymph node involvement are rare. Various forms of abdominal [3, 4] and neurological [5, 6] tubercular involvement in HIV infection have been reported. But tuberculosis presenting simultaneously with mesenteric and brain abscess has not been reported yet. We report a case of disseminated tuberculosis presenting as mesenteric and cerebral abscess in a HIV case without involving lung and lymph nodes. Bone marrow smears and fine needle aspiration cytology (FNAC) from mesenteric lesion were positive for acid fast bacilli (AFB) and the diagnosis of tuberculosis was confirmed by positive polymerase chain reaction (PCR). He responded well to treatment with anti tubercular drugs.
Assuntos
Adulto , Humanos , Masculino , Infecções Oportunistas Relacionadas com a AIDS/complicações , Abscesso Encefálico/etiologia , Mesentério/microbiologia , Doenças Peritoneais/etiologia , Tuberculose/complicações , Abscesso , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antituberculosos/uso terapêutico , Biópsia por Agulha Fina , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/tratamento farmacológico , Mesentério/patologia , Reação em Cadeia da Polimerase , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/tratamento farmacológico , Tomografia Computadorizada por Raios X , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológicoRESUMO
Disseminated tuberculosis in HIV infection involves multiple organs. Pulmonary and lymph node involvement are the commonest form of tuberculosis in HIV infection [1, 2]. Other forms of tuberculosis in the absence of lung and lymph node involvement are rare. Various forms of abdominal [3, 4] and neurological [5, 6] tubercular involvement in HIV infection have been reported. But tuberculosis presenting simultaneously with mesenteric and brain abscess has not been reported yet. We report a case of disseminated tuberculosis presenting as mesenteric and cerebral abscess in a HIV case without involving lung and lymph nodes. Bone marrow smears and fine needle aspiration cytology (FNAC) from mesenteric lesion were positive for acid fast bacilli (AFB) and the diagnosis of tuberculosis was confirmed by positive polymerase chain reaction (PCR). He responded well to treatment with anti tubercular drugs.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Abscesso Encefálico/etiologia , Mesentério/microbiologia , Doenças Peritoneais/etiologia , Tuberculose/complicações , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Abscesso , Adulto , Antituberculosos/uso terapêutico , Biópsia por Agulha Fina , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/tratamento farmacológico , Humanos , Masculino , Mesentério/patologia , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/tratamento farmacológico , Reação em Cadeia da Polimerase , Tomografia Computadorizada por Raios X , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológicoRESUMO
The use of dapsone is increasing even though overdose is rarely reported and physicians must be aware of its toxicity and management. Mortality can occur due to methemoglobinemia and hemolytic anemia. Although activated charcoal and methylene blue are recommended, the use of hemodialysis is reported only in few studies. Literature on the kinetic profile indicates that 50% to 80% of dapsone is protein bound and indicates a possibility to dialyze the unbound form. This study describes a case of deliberate severe dapsone overdose with cyanosis, methemoglobinemia, and hemolytic anemia, which improved after repetitive hemodialysis.
