Nodal radiotherapy in refractory tuberculosis in an AIDS patient

A 25-year-old female with transfusion-associated acquired immunodeficiency syndrome (AIDS) treated with zidovudine (AZT) developed cervical lymph node enlargement. The histological study disclosed granulomas and the culture revealed M. tuberculosis. The patient was treated with isoniazid, rifampicin and pirazynamide and the lymphadenomegaly resolved. Five years later, with a CD4 cell count of 245, the lymph node enlargement reappeared, the biopsy and special studies confirming tuberculosis (TB). She was then given ciprofloxacin, azithromycin, ethambutol, amikacin and pirazynamide without success. In two instances the enlarged nodes were surgically removed. Facing progressive obstruction of both the airway and the esophagus, localized radiotherapy (1800 cGy in nine fractions) to the right aspect of the neck was delivered with dramatic resolution of the node enlargement; however, dissemination of the infection leading to a severe lung infiltration and respiratory failure ended the life of the patient.