Re-Print: An Interesting Case of Disseminated Tuberculoma of Brain and Spinal Cord Type of Study: Case Report

Tuberculosis is an important public problem worldwide from 19th century. Manifestations of tuberculosis widely classified as pulmonary and extra pulmonary manifestations. Central nervous system (CNS) tuberculosis is a serious condition where patients most often present with seizure. Tuberculoma is one of the CNS manifestations of tuberculosis. The imaging feature of tuberculoma is ring enhancing lesions. Tuberculoma should be differentiated from other diseases with ring enhancing lesions like neurocysticercosis, coccidiomycosis, toxoplasmosis and malignancies.

A Case of Rarest Presentation of CNS Tuberculosis as Disseminated Miliary Tuberculoma Brain

Introduction: Disseminated miliary forms of tuberculoma in brain are rarest form of CNS tuberculosis. It is one of the differential diagnoses of ring enhancing multiple brain lesions. We are reporting an interesting case of 28 year old lady with disseminated tuberculosis with miliary brain tuberculomas. Case presentation: 28 yrs lady with no known previous co-morbidities presented with low grade evening rise in temperature and mild to moderate continues global headache for 10 days associted with nausea and recurrent vomiting, and weight loss of 4 kg. Her ESR, blood count, liver and renal function tests were within normal values. HIV was negative by ELISA. Sputum for Acid Fast bacilli was +3 positive for mycobacterium tuberculosis bacilli. Cerebrospinal Fluid cytological analysis was normal and ADA was 9.1 U/L. Urine microscopic examination was positive for +++ MTB. Chest X ray showed bilateral military opacities. High Resolution CT of Chest was suggestive of miliary distribution of nodules in bilateral lungs. MRI Brain showed discrete ring enhancing lesions scattered in left temporal lobe, and right frontal lobe are located at grey-white matter junctions. In infra- tentorial lesion were at the level of pons, mid brain, inferior cerebellar peduncle and bilateral cerebellar hemispheres. Few of the lesions in right precentral gyrus showing associated mild perilesional edema.Conclusion: Clinician should consider miliary tuberculosis brain in tuberculosis endemic region, in a clinical setting where atypical multiple ring enhancing lesions even with non inflammatory CSF but with presence of other markers of tuberculosis is present.

Characteristics of cerebrospinal fluid under tuberculosis in patients with HIV-infection

Purpose. To carry out an analysis of characteristics and to reveal the peculiarities of laboratory changes of cerebrospinal fluid (CSF) in patients with tuberculosis of central nervous system associated with HIV-infection.Materials and methods. Analysis of 206 patients with CNS tuberculosis associated with HIV-infection who were treated in State Budgetary Healthcare Institution «City tuberculosis hospital No. 2» of Saint Petersburg during the period from 2006 to 2018 was conducted.Results and discussion. It was concluded that a mean protein level in CSF was 1,6±0,1 g/l and was significantly increased in patients with tubercular meningoencephalomyelitis. When decreasing the amount of CD4-lymphocytes, increasing of protein level in cerebrospinal fluid is observed. As cytosis increases, the amount of neutrophils increases too. Patients with tuberculous meningitis showed remarkable pleocytosis in comparison with patients with meningocephalitis. In 47% of cases, neutrophilic cell composition of CSF was registered. Therewith, the rate of neutrophils in CSF increased as the rate of lymphocytes decreased. Reducing of glucose in CSF was observed in the majority of patients with CNS tuberculosis independently of severity of immunosuppression and extent of brain injury.

Intracranial Tuberculoma Mimicking Neurosarcoidosis: A Clinical Challenge

Central nervous system (CNS) tuberculosis is a rare manifestation of all tuberculosis presentations. The incidence of brain tuberculoma is increasing in developed countries due to HIV infection and immigration from tuberculosis-endemic countries. Symptoms and radiologic findings of CNS tuberculosis can be non-specific and lead to misdiagnosis or mistreatment. Intracranial tuberculoma can present with a seizure, intracranial hypertension, or focal neurologic symptoms. In our case, the diagnosis was challenging between neurosarcoidosis and intracranial tuberculoma due to inconclusive results of stereotactic brain biopsy and clinical presentation. The pathology result of the open brain biopsy revealed non-caseating granuloma. Finally, we were able to diagnose intracranial tuberculoma following acid-fast bacilli culture results of open brain biopsy. This report highlights the importance of including intracranial tuberculoma in the differential diagnosis of cerebral space-occupying lesions, even in patients with negative laboratory findings of tuberculosis.

Central nervous system Tuberculomas in a patient with disseminated multi-drug resistant tuberculosis; A case report

Tuberculosis (TB) is one of the leading causes of death worldwide, particularly in low- and middle-income countries. Although Mycobacterium tuberculosis can involve any organ, most commonly the lung, central nervous system (CNS) tuberculosis is the most devastating form of the disease. Tuberculoma is the most common parenchymal lesion in CNS tuberculosis which could be found in any portion of the intracranial space. The global rates and numbers of drug resistant TB are rising. With increasing globalization, the spread of drug-resistant strains of TB has become a mounting global public health concern. We present a case of 27-year-old male with disseminated multi-drug resistant (MDR) TB who presented with neurological symptoms and multiple CNS Tuberculomas. The patient was started on regimen for Multi-drug resistant tuberculosis (MDR-TB), which allowed the serial resolution of intracranial tuberculomas. Keywords: Tuberculosis (TB), Multi-drug resistant (MDR) TB, Central nervous system (CNS) TB, Tuberculoma, MRI brain

Starry sky appearance of tuberculoma

CNS tuberculosis accounts for only 10% of all cases of tuberculosis, carries a high mortality and morbidity. Tuberculoma of the brain is an important clinical entity. The main challenge in the management of brain tuberculoma is its diagnosis. Hereby, referring case of a 12 years old male child who presented with clinical picture of tuberculosis but radiologically NCC, hence posing a diagnostic dilemma as clinically it was in the favor of tuberculosis whereas radiologically inclination was towards neurocysticercosis. Based on clinical manifestations it was suggestive of meningitis, CSF picture was suggestive of hypoglycorrhachia. CT chest showed miliary pattern and neuroimaging showing multiple ring enhancing lesions. High index of clinical suspicion is required to make a diagnosis and evaluation with reports.

Frequency of HIV in Patients with Central Nervous System Tuberculosis

Background: Tuberculosis (TB) is the most widely recognized reason for death in patients of acquired immune deficiency syndrome (AIDS). Human Immunodeficiency virus (HIV) and AIDS continue to be on an increase in Pakistan. This study aimed to assess the magnitude of HIV among patients with Central nervous system (CNS) tuberculosis as its progression to AIDS significantly influences mortality in these patients. The main objective of the study was to determine the frequency of HIV among patients with CNS tuberculosis. Methods: This Cross-Sectional study was conducted at Medicine Wards of Civil Hospital, Karachi from 7th October 2016 to 7th April 2017. A total of 140 newly diagnosed Central Nervous System tuberculosis patients were included. Blood sample collected for HIV test (ELISA) was interpreted as either: Reactive for HIV or Non-reactive for HIV. HIV infection was considered as HIV positive by using 3 Rapid Diagnostic testing kits according to guidelines of World Health Organization (WHO). All the patient data were collected through a pre-designed proforma. Data were analyzed using SPSS v.23.0. Chi-square test was applied post stratification with p- value≤0.05 taken as statistically significant. Results: Sixteen patients (11.43%) of CNS tuberculosis were found to have HIV positive results. Out of total 140 patients, 50(35.71%) were female and 90(64.29%) were male. The average age of the patients was 39.37±12.8 years. Conclusion: CNS tuberculosis can be the primary clinical manifestation of HIV positive patients. Early recognizable proof of HIV in patients with CNS tuberculosis may warrant early inception of anti-HIV treatment.