MRI appearances of tuberculous meningitis in HIV-infected children: A paradoxically protective mechanism?
Immune suppression predisposes HIV-infected children to opportunistic infections including Mycobacterium tuberculosis. HIV infection increases the risk of progression to active disease and also increases the risk for extrapulmonary involvement, including tuberculous meningitis (TBM). Brain injury in TBM is the consequence of an immune-mediated vasculopathy. HIV-related immune dysfunction prevents the production of thick exudates that cause parenchymal infarctions and cerebrospinal fluid flow obstruction. It could be postulated that HIV may be 'protective from some of the common complications related to TBM. The aim of this paper is to highlight the 'protective features of HIV-related immune suppression observed on MRI in children with TBM and promote the use of MRI for detecting subtle and atypical meningeal enhancement in HIV and TBM coinfected children. © 2012 Future Medicine Ltd.