Multi-Organ Failure in a Known Tuberculosis and Diabetic Patient with Advanced HIV Disease

People living with HIV are at an increased risk of not only infectious co-morbidities but also the co-existence of HIV with other chronic illnesses, notably non-communicable diseases (NCDs). Confronting the dual epidemic of HIV and its co-existence with both infectious and NCDs is a public health priority especially in countries with higher HIV burden. It is in this population that extra pulmonary or disseminate forms of tuberculosis contributing to high morbidity and mortality are likely to be reported more so in late presentation. One such presentation of a disseminated type of disease in TB may involve the meningitis to cause tuberculous meningitis. The clinical presentation of tuberculous meningitis in HIV-infected individuals may include headaches, seizures and, cranial imaging may reveal space occupying lesions such as a tuberculoma and the yield of culture of cerebrospinal fluid may also be greater. Given that delayed initiation of therapy is a strong predictor of mortality in cases of tuberculous meningitis, health care providers must consider tuberculosis in the differential diagnosis of the HIV-infected individual with lymphocytic meningitis. The presentation in this case report is further compounded by the state of nephropathy associated with encephalopathy probably secondary to obstructive uropathy in BPH, viral Hepatitis B and diabetes mellitus

Keywords: TB meningitis, CD4+ count, Viral load, Diabetes, BPH, Obstructive uropathy, Acute kidney Injury.