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A rare case of central nervous system tuberculosis.

Parekh R, Haftka A, Porter A - Case Rep Infect Dis (2014)

Bottom Line: Chest radiography and CT of chest showed no positive findings.A subsequent MRI one month later showed profound worsening of the lesions with increasing vasogenic edema and newly found mass effect impinging on the fourth ventricle.The diagnosis of CNS TB was finally confirmed by positive acid-fast bacilli (AFB) cultures.

View Article: PubMed Central - PubMed

Affiliation: Henry Ford Hospital, Henry Ford Health System, 2799 West Grand Boulevard, K-7, Detroit, MI 48202, USA.

ABSTRACT
Intracranial abscess is an extremely rare form of central nervous system (CNS) tuberculosis (TB). We describe a case of central nervous system tuberculous abscess in absence of human immunodeficiency virus (HIV) infection. A 82-year-old Middle Eastern male from Yemen was initially brought to the emergency room due to altered mental status and acute renal failure. Cross-sectional imaging revealed multiple ring enhancing lesions located in the left cerebellum and in bilateral frontal lobe as well as in the inferior parietal lobe on the left. The patient was placed on an empiric antibiotic regimen. Preliminary testing for infectious causes was negative. Chest radiography and CT of chest showed no positive findings. He was not on any immunosuppressive medications and human immunodeficiency virus (HIV) enzyme immunoassay (EIA) test was negative. A subsequent MRI one month later showed profound worsening of the lesions with increasing vasogenic edema and newly found mass effect impinging on the fourth ventricle. Brain biopsy showed focal exudative cerebellitis and inflamed granulation tissue consistent with formation of abscesses. The diagnosis of CNS TB was finally confirmed by positive acid-fast bacilli (AFB) cultures. The patient was started on standard tuberculosis therapy but expired due to renal failure and cardiac arrest.

No MeSH data available.


Related in: MedlinePlus

Magnetic resonance imaging of the brain showing ring enhancing lesion in the left cerebellum with mass effect on the fourth ventricle, on initial presentation.
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fig3: Magnetic resonance imaging of the brain showing ring enhancing lesion in the left cerebellum with mass effect on the fourth ventricle, on initial presentation.

Mentions: An 82-year-old Middle Eastern male from Yemen with past medical history significant for atrial fibrillation (A-fib), type 2 diabetes mellitus, cryptogenic cirrhosis, and prostate cancer was initially brought to the emergency room due to altered mental status and acute renal failure. Computed tomography (CT) scan of the head and magnetic resonance imaging (MRI) of the brain revealed multiple ring enhancing lesions located in the left cerebellum, in bilateral frontal lobe, and in the inferior parietal lobe on the left (Figures 1, 2, and 3). The initial impression was infectious versus metastatic process as the patient had a recent history of prostate cancer; however, prostate specific antigen (PSA) levels were undetectable. The patient was placed on an empiric antibiotic regimen that included intravenous vancomycin, cefepime, and metronidazole based on Infectious Diseases Recommendation. Preliminary testing for infectious causes included an extensive workup including blood cultures, Fungitell, tuberculin skin (PPD) testing, bronchoalveolar lavage with culture, and interferon gamma release assay (Quantiferon) test for tuberculosis that was all negative. Chest radiography and CT of chest were also done which showed no positive findings. He was not on any immunosuppressive medications and human immunodeficiency virus (HIV) enzyme immunoassay (EIA) test was negative. While on intravenous antibiotics, patient initially had a marginal response with diminishing lesions and decreasing vasogenic edema on repeat MRI of brain after 2 weeks along with improving mental status.


A rare case of central nervous system tuberculosis.

Parekh R, Haftka A, Porter A - Case Rep Infect Dis (2014)

Magnetic resonance imaging of the brain showing ring enhancing lesion in the left cerebellum with mass effect on the fourth ventricle, on initial presentation.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4248556&req=5

fig3: Magnetic resonance imaging of the brain showing ring enhancing lesion in the left cerebellum with mass effect on the fourth ventricle, on initial presentation.
Mentions: An 82-year-old Middle Eastern male from Yemen with past medical history significant for atrial fibrillation (A-fib), type 2 diabetes mellitus, cryptogenic cirrhosis, and prostate cancer was initially brought to the emergency room due to altered mental status and acute renal failure. Computed tomography (CT) scan of the head and magnetic resonance imaging (MRI) of the brain revealed multiple ring enhancing lesions located in the left cerebellum, in bilateral frontal lobe, and in the inferior parietal lobe on the left (Figures 1, 2, and 3). The initial impression was infectious versus metastatic process as the patient had a recent history of prostate cancer; however, prostate specific antigen (PSA) levels were undetectable. The patient was placed on an empiric antibiotic regimen that included intravenous vancomycin, cefepime, and metronidazole based on Infectious Diseases Recommendation. Preliminary testing for infectious causes included an extensive workup including blood cultures, Fungitell, tuberculin skin (PPD) testing, bronchoalveolar lavage with culture, and interferon gamma release assay (Quantiferon) test for tuberculosis that was all negative. Chest radiography and CT of chest were also done which showed no positive findings. He was not on any immunosuppressive medications and human immunodeficiency virus (HIV) enzyme immunoassay (EIA) test was negative. While on intravenous antibiotics, patient initially had a marginal response with diminishing lesions and decreasing vasogenic edema on repeat MRI of brain after 2 weeks along with improving mental status.

Bottom Line: Chest radiography and CT of chest showed no positive findings.A subsequent MRI one month later showed profound worsening of the lesions with increasing vasogenic edema and newly found mass effect impinging on the fourth ventricle.The diagnosis of CNS TB was finally confirmed by positive acid-fast bacilli (AFB) cultures.

View Article: PubMed Central - PubMed

Affiliation: Henry Ford Hospital, Henry Ford Health System, 2799 West Grand Boulevard, K-7, Detroit, MI 48202, USA.

ABSTRACT
Intracranial abscess is an extremely rare form of central nervous system (CNS) tuberculosis (TB). We describe a case of central nervous system tuberculous abscess in absence of human immunodeficiency virus (HIV) infection. A 82-year-old Middle Eastern male from Yemen was initially brought to the emergency room due to altered mental status and acute renal failure. Cross-sectional imaging revealed multiple ring enhancing lesions located in the left cerebellum and in bilateral frontal lobe as well as in the inferior parietal lobe on the left. The patient was placed on an empiric antibiotic regimen. Preliminary testing for infectious causes was negative. Chest radiography and CT of chest showed no positive findings. He was not on any immunosuppressive medications and human immunodeficiency virus (HIV) enzyme immunoassay (EIA) test was negative. A subsequent MRI one month later showed profound worsening of the lesions with increasing vasogenic edema and newly found mass effect impinging on the fourth ventricle. Brain biopsy showed focal exudative cerebellitis and inflamed granulation tissue consistent with formation of abscesses. The diagnosis of CNS TB was finally confirmed by positive acid-fast bacilli (AFB) cultures. The patient was started on standard tuberculosis therapy but expired due to renal failure and cardiac arrest.

No MeSH data available.


Related in: MedlinePlus