Coinfection of Tuberculosis in an Undiagnosed HIV, AIDS Patient Presenting With Shortness of Breath, Constitutional Symptoms and Lymphadenopathy

Abstract

Tuberculosis (TB) has long been known as an acquired immunodeficiency syndrome (AIDS) defining illness in human immunodeficiency virus (HIV) patients, causing reciprocal advantage for both pathogens throughout the course of the disease, not just constituting a burden for the patient, but also impacting public health globally. We report a case of a 42-year-old man who presented with shortness of breath, generalized lymphadenopathy and weight loss. Subsequently diagnosed with HIV/AIDS and generalized ganglionar TB. Initial computed tomography (CT) of the chest showed extensive mediastinal involvement with large right loculated pleural effusion, with growth of acid-fast bacilli (AFB) on culture. Biopsy of lymph nodes confirmed pathologic changes correlating with M. tuberculosis (Caseating granulomatous inflammation), ruling out the possibility of lymphoproliferative disorder. Multiple factors contribute to the immune system decline in AIDS patients, moreover the rapid depletion of Tuberculosis antigen-specific CD4+ T before generalized CD4+T cells. Early assessment for the presence of co-infection and guidance of targeted therapy is critical for management and an important factor in the expected recovery of such patients. Therefore, understanding the pathogenesis of the co-infection, diagnostic approach, possible complications, and the action of concurrent therapy highly active antiretroviral therapy (HAART)/anti-Tuberculosis treatment as well as drug cytotoxicity is paramount.