The Indian Journal of Tuberculosis - LRS Institute of Tuberculosis ...

HIV INFECTION AND PULMONARY TUBERCULOSIS 37
Table 1. Report on T cell typing employing Dako*
monoclonals and immunohistochemical
technique (in cases 1 & 2)
Cell Case 1
type
Case 2
Laboratory
controls
Lymphocytes/cmm 6588 682 more than 1500
CD4-T cells 1449 191 622-3510
CD8-T cells 4282 109 277-1728
CD4:CD8 Ratio 0.388 1.752 1.023-2.695
Note 1: In case 1 there is no decrease in T4 cells, but
CD4/CD8 ratio is decreased because of
increased cytotoxic T cells. 2: In case 2 there
is decrease in T4 and T8 cells
and the ratio CD4/CD8 is within normal
limits.
* Performed at the immunology laboratory of
Christian Medical College and Hospital, Vellore.
Fig. 3. Skiagram of chest showing bilateral diffuse
fibrocaseous infiltrations
bilateral diffuse infiltrates (Fig. 3). Sputum smear
was positive for AFB.
As the patient had prior chemotherapy for
about 2 years, with regimens containing
Streptomycin, INH, Rifampicin and
Pyrazinamide, he was put on Kanamycin,
Ethionamide, Cycloserine, and INH (high dose).
The sensitivity results obtained later showed
strains resistant to Streptomycin, INH and
Rifampicin. Patient developed an erythematous
rash while on treatment which was treated first as
non specific dermatitis but showed only partial
clearing. After 6 weeks, the same rash was
diagnosed as tinea infestation and treated with
whitefield ointment with complete clearing. Antituberculosis
treatment had been temporarily
stopped after the appearance of rash. When it
was restarted, one drug at a time, it was found
that the patient did not tolerate Kanamycin,
which was discontinued. The patient developed
Herpes Zoster over the right back, localized to
T8 and T9, later spreading to LI and L2 as well.
This prompted us to look for HIV infection. With
topical creams and steroids, it responded slowly
to treatment. After four months of
chemotherapy, there was some radiological
improvement but the sputum smear remained
positive. He was discharged with advice to
continue drugs on domiciliary basis. When the
HIV result became available, the patient was
readmitted on 9.1.1991. He was found smear
positive even alter 6 months of chemotherapy,
although he was clinically better,
On readmission, he was put on Ethambutol,
Ethionamide, INH, Oflaxacin and Trimethoprim
Sulpha combination. The patient developed
vomiting, off and on, and drugs had to be stopped
for brief periods. The patient had urticarial rash,
due to intolerance to Trimethoprim-Sulpha
combination and haemop-tysis for which styptics
were given. He developed Tinea corporis again.
This did not respond to Whitefield ointment for
which reason Ketoconazole was given with
remarkable improvement. On 5.5.1991, the
patient complained of chest pain and
breathlessness due to a left sided pneumothorax,
which was managed by intercostal tube drainage.
Later, the patient complained of throat pain and
began bringing out cartilage like material in
sputum. The E.N.T. specialist diagnosed it as
pharyngitis sica. The patient had a bout of
haemoptysis on 17.5.1991, followed by sudden
dyspnea and cardiorespiratory arrest. All
measures of resuscitation failed and the patient
expired.