CTICasesDisseminated Tuberculosis in HIV/AIDS
Imaging findings
A young female from Botswana presented with malaise, an abnormal mediastinum on radiograph, and extensive centrally low-attenuation (necrotic) lymphadenopathy in the mediastinum, hila, and abdomen on CT. Small foci of central lobular and tree-in-bud nodules were present in the right upper lobe. Follow-up imaging showed a more diffuse miliary pattern. Axillary lymph nodes also demonstrated central necrosis.
Key takeaways
Extensive necrotic lymphadenopathy, especially in an immigrant from an endemic area with newly diagnosed HIV/AIDS, should strongly suggest tuberculosis rather than lymphoproliferative disorders. Concomitant central lobular/tree-in-bud nodules and evolving miliary patterns further support this diagnosis. Mycobacterium avium complex (MAC) should also be considered in HIV patients with similar findings due to their similar appearance of low attenuation lymph nodes.
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