Rev Clin Esp. 1996 Dec;196(12):816-20. Unique Identifier : AIDSLINE
BACKGROUND: Tuberculosis (TB) with liver and/or spleen abscess HSA)
formation in HIV-positive patients is uncommon. PATIENTS AND METHODS:
One hundred and thirty-seven HIV positive patients with TB were studied
from January 93 to June 95. Patients with tuberculous HSA were enrolled
in the study. Diagnosis was obtained by recovery of Mycobacterium
tuberculosis in clinical specimens and the presence of hypoechogenic
lesions in liver and/or spleen. RESULTS: M. tuberculosis isolates were
resistant to some of the usual drugs in 51 patients. Twenty of these
patients had HSA (39%) and in 18 patients the antibiotic sensitivity
testing showed resistance to isoniazid, rifampin, ethambutol, and
streptomycin. The remaining 86 patients had episodes of TB with
drug-susceptible microorganism and only three patients had HSA (3%) (p <
0.001). The 23 patients with tuberculous HSA had a mean CD4+ lymphocyte
count of 33 x 10(6) cells/L (2-111) and 7 had a previous episode of TB.
The abdominal echography showed hepatosplenomegaly in all cases.
Abscesses were located at the liver in 12 patients (52%), spleen in 18
(78%) and both organs in 7 (30%). In 16 cases a corticosteroid therapy
was indicated. In the 3 patients with susceptible TB and HSA the
clinical course was good. The 20 patients with resistant TB died.
CONCLUSION: Abdominal TB in HIV-positive patients and HSA formation
appears to be more common in severely immunosuppressed patients, with
resistant TB and its mortality rate is high. The response to therapy
with antituberculous drugs is slow and sometimes the administration of
corticosteroids is necessary for the resolution of symptoms.
*HIV Seropositivity/COMPLICATIONS *Liver Abscess/COMPLICATIONS
*Splenic Diseases/COMPLICATIONS *Tuberculosis, Hepatic/COMPLICATIONS
*Tuberculosis, Multidrug-Resistant/COMPLICATIONS *Tuberculosis,