Objective:

To identify intersections between tuberculous vasculitis and Kikuchi-Fujimoto Disease (KFD) leading to stroke in an immunocompromised person.

Background:

Stroke in an immunocompromised patient with aggressive meningoencephalitis could result from tuberculous vasculitis, or, rarely, it could be attributed to KFD, which can co-exist with infections such as tuberculosis (TB) and human immunodeficiency virus (HIV).

Design/Methods:

NA

Results:

A 42-year-old male with a past medical history of HIV infection presented with fever, headaches, and progressive altered mentation over the course of two weeks. No history of autoimmune conditions. He demonstrated signs of meningismus and had a rapid neurological decline. On examination, enlarged lymph nodes could be palpated in the left inguinal region: tenderness was unassessed as he was comatose. An initial CT brain was unremarkable. MRI brain showed restricted diffusion in the right caudate, thalamus, and bilateral frontal-temporal lobes, hydrocephalus, and leptomeningeal enhancement extending from the frontal-temporal regions to the pons and cerebellar hemispheres. Cerebral angiogram demonstrated vasculitis in both middle cerebral arteries. CSF analysis, initially deferred due to rigidity, was later performed and was positive for Mycobacterium tuberculosis complex (MTBC). Lymph node biopsy revealed necrotizing granulomatous lymphadenitis, compatible with KFD, and was negative for bacterial, fungal, and acid-fast organisms. EEG prompted by myoclonic status indicated encephalopathy with no epileptiform discharge. Subsequent CT brain showed worsening ventriculomegaly, warranting an external ventricular drain (EVD) placement. Anti-tuberculosis therapy was started due to suspicion of TB meningoencephalitis (TBM). Unfortunately, the patient’s condition worsened, and the healthcare proxy withdrew care after a 6-week hospitalization.

Conclusions:

Recognition of dual pathologies and identification of immunopathogenic links between TB and KFD in an immunocompromised person can prevent misdiagnosis and ensure appropriate treatment. The case exhibits rapid progression of disease in immune-infectious mechanisms and reports a constellation of conditions that have rarely been seen together.