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Pulmonary Tuberculosis in AIDS Patients

Transient Chest Radiographic Worsening After Initiation of Antiretroviral Thrapy

Joel E. Fishman1, Efrat Saraf-Lavi1, Masahiro Narita2, Elena S. Hollender2, Rajeev Ramsinghani1 and David Ashkin2

1 Department of Radiology, University of Miami School of Medicine, Jackson Memorial Hospital, West Wing 279, 1611 N.W. 12th Ave., Miami, FL 33136.
2 A. G. Holley State Tuberculosis Hospital, 1199 W. Lantana Rd., Lantana, FL 33462.



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  		Fig. 1. —Worsened pulmonary parenchymal disease in 41-year-old woman with AIDS who underwent antiretroviral therapy.

A, Chest radiograph obtained at admission shows mild diffuse reticulonodular opacities.

 


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  		Fig. 1. —Worsened pulmonary parenchymal disease in 41-year-old woman with AIDS who underwent antiretroviral therapy.

B, Chest radiograph obtained after 1 month of antituberculous therapy shows resolution of opacities. Patient subsequently underwent antiretroviral therapy.

 


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  		Fig. 1. —Worsened pulmonary parenchymal disease in 41-year-old woman with AIDS who underwent antiretroviral therapy.

C, Chest radiograph obtained after 1 month of antiretroviral therapy shows diffuse miliary disease. Patient also manifested fever and cervical lymphadenopathy (not shown). Both antituberculous therapy and antiretroviral therapy were discontinued.

 


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  		Fig. 1. —Worsened pulmonary parenchymal disease in 41-year-old woman with AIDS who underwent antiretroviral therapy.

D, Chest radiograph obtained 2 months after C shows improvement in miliary opacities. Fever and lymphadenopathy had also resolved. Combination therapy was begun again without subsequent radiographic worsening.

 


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  		Fig. 2. —Worsening pulmonary consolidation in 33-year-old woman with AIDS who underwent antiretroviral therapy.

A, Chest radiograph obtained after 1 month of antituberculous therapy shows mild left upper and lower lobe opacities (arrows). Mild left hilar enlargement is possible.

 


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  		Fig. 2. —Worsening pulmonary consolidation in 33-year-old woman with AIDS who underwent antiretroviral therapy.

B, Chest radiograph obtained shortly after beginning antiretroviral therapy shows worsened left lower lobe consolidation. Patient also developed fever and ascites. Cultures failed to detect superimposed infection, and combined therapy was continued.

 


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  		Fig. 2. —Worsening pulmonary consolidation in 33-year-old woman with AIDS who underwent antiretroviral therapy.

C, Follow-up chest radiograph 2 months after B shows interval clearing of consolidation.

 


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  		Fig. 3. —Development of lymphadenopathy in 36-year-old woman with AIDS who underwent antiretroviral therapy.

A, Chest radiograph obtained at admission shows no adenopathy.

 


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  		Fig. 3. —Development of lymphadenopathy in 36-year-old woman with AIDS who underwent antiretroviral therapy.

B, Chest radiograph obtained within 1 week after commencement of antiretroviral therapy shows right paratracheal adenopathy (arrowheads) and right cervical and supraclavicular adenopathy (asterisk). Patient also developed fever. Biopsy of the cervical node showed noncaseating granuloma. Combination therapy was continued, and steroids were added to reduce symptoms from extensive adenopathy. Findings on chest radiograph obtained at conclusion of antituberculous therapy (not shown) were normal.

 

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