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Concurrent intra-cranial tuberculoma and tuberculous abscesses: A rare combination.

Senapati SB, Mishra SS, Das S, Satpathy MC - J Pediatr Neurosci (2014 Sep-Dec)

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, SCB Medical College and Hospital, Cuttack, Odisha, India.

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Dear Sir, Although tuberculosis of the central nervous system is well-known, the incidence of tuberculous brain abscesses (TBAs) is rare, more so its association with concurrent intra-cranial tuberculoma... Plain computed tomography (CT) scan revealed right fronto-parietal multiple cystic lesions with a separate solid component [Figure 1a]... An urgent craniotomy was done, straw colored cystic fluid aspirated followed by removal of multiple cysts one after another... It was removed in piecemeal totally [Figure 2]... Postoperative CT scan confirmed total removal of the lesion with relief of hydrocephalous [Figure 1b]... Patient's screening for any systemic source of tuberculosis was negative... Postoperatively child improved clinically... The diagnosis of tuberculous brain abscess is, usually, suspected in immunocompromised patients with or without human immunodeficiency virus infection or in an immunocompetent patient from an endemic region with a pulmonary focus of infection... This pulmonary focus of infection is, usually, present in only 30% of cases... In vivo proton magnetic resonance (MR) spectroscopy and magnetization transfer MR imaging may differentiate tuberculous from pyogenic abscesses and influence management... Newer techniques like polymerase chain reaction may provide a useful tool for diagnosis of tuberculosis from paucibacillary specimens like pus in which conventional methods may show low sensitivity... Recently in vitro proton MR spectroscopy was evaluated for the diagnosis of TBA... Absence of multiplet of amino acids-lipids at 0.9 ppm seems to be a hallmark of TBA.

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The Ziehl Neelsen stain of pus showing many acid-fast bacilli and pus cells
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Figure 4: The Ziehl Neelsen stain of pus showing many acid-fast bacilli and pus cells

Mentions: A 6-year-old immunocompetent child with contact history of tuberculosis, presented to us in unconscious state with complains of intermittent fever, night sweats, headache, left sided weakness and progressive visual impairment in both eyes for last 4 months. Two days back he had several episodes of left sided complex partial seizure, following which he became unconscious. Neurological evaluation showed a decorticating child with secondary optic atrophy. Plain computed tomography (CT) scan revealed right fronto-parietal multiple cystic lesions with a separate solid component [Figure 1a]. There was perilesional edema, midline shift and herniation. An urgent craniotomy was done, straw colored cystic fluid aspirated followed by removal of multiple cysts one after another. All the cysts were well encapsulated having clear cyst-parenchyma interface. Solid component was firm, yellowish white, avascular and well demarcated. It was removed in piecemeal totally [Figure 2]. Postoperative CT scan confirmed total removal of the lesion with relief of hydrocephalous [Figure 1b]. Histopathological examination of solid component showed a granulomatous inflammation with central caseous necrosis, containing epithelioid cells and multinucleated giant (Langhans) cells, whereas the histopathological examination of cyst wall showed chronic inflammatory cells without granuloma formation [Figure 3]. Ziehl Neelsen staining of pus revealed the acid fast bacilli and pus cells [Figure 4]. Patient's screening for any systemic source of tuberculosis was negative. Postoperatively child improved clinically. He was discharged with anti-tubercular regimen (Category II regimen of DOTS) started and continued for 15 months. At 2 years follow-up, the patient was doing well.


Concurrent intra-cranial tuberculoma and tuberculous abscesses: A rare combination.

Senapati SB, Mishra SS, Das S, Satpathy MC - J Pediatr Neurosci (2014 Sep-Dec)

The Ziehl Neelsen stain of pus showing many acid-fast bacilli and pus cells
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4302564&req=5

Figure 4: The Ziehl Neelsen stain of pus showing many acid-fast bacilli and pus cells
Mentions: A 6-year-old immunocompetent child with contact history of tuberculosis, presented to us in unconscious state with complains of intermittent fever, night sweats, headache, left sided weakness and progressive visual impairment in both eyes for last 4 months. Two days back he had several episodes of left sided complex partial seizure, following which he became unconscious. Neurological evaluation showed a decorticating child with secondary optic atrophy. Plain computed tomography (CT) scan revealed right fronto-parietal multiple cystic lesions with a separate solid component [Figure 1a]. There was perilesional edema, midline shift and herniation. An urgent craniotomy was done, straw colored cystic fluid aspirated followed by removal of multiple cysts one after another. All the cysts were well encapsulated having clear cyst-parenchyma interface. Solid component was firm, yellowish white, avascular and well demarcated. It was removed in piecemeal totally [Figure 2]. Postoperative CT scan confirmed total removal of the lesion with relief of hydrocephalous [Figure 1b]. Histopathological examination of solid component showed a granulomatous inflammation with central caseous necrosis, containing epithelioid cells and multinucleated giant (Langhans) cells, whereas the histopathological examination of cyst wall showed chronic inflammatory cells without granuloma formation [Figure 3]. Ziehl Neelsen staining of pus revealed the acid fast bacilli and pus cells [Figure 4]. Patient's screening for any systemic source of tuberculosis was negative. Postoperatively child improved clinically. He was discharged with anti-tubercular regimen (Category II regimen of DOTS) started and continued for 15 months. At 2 years follow-up, the patient was doing well.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, SCB Medical College and Hospital, Cuttack, Odisha, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Dear Sir, Although tuberculosis of the central nervous system is well-known, the incidence of tuberculous brain abscesses (TBAs) is rare, more so its association with concurrent intra-cranial tuberculoma... Plain computed tomography (CT) scan revealed right fronto-parietal multiple cystic lesions with a separate solid component [Figure 1a]... An urgent craniotomy was done, straw colored cystic fluid aspirated followed by removal of multiple cysts one after another... It was removed in piecemeal totally [Figure 2]... Postoperative CT scan confirmed total removal of the lesion with relief of hydrocephalous [Figure 1b]... Patient's screening for any systemic source of tuberculosis was negative... Postoperatively child improved clinically... The diagnosis of tuberculous brain abscess is, usually, suspected in immunocompromised patients with or without human immunodeficiency virus infection or in an immunocompetent patient from an endemic region with a pulmonary focus of infection... This pulmonary focus of infection is, usually, present in only 30% of cases... In vivo proton magnetic resonance (MR) spectroscopy and magnetization transfer MR imaging may differentiate tuberculous from pyogenic abscesses and influence management... Newer techniques like polymerase chain reaction may provide a useful tool for diagnosis of tuberculosis from paucibacillary specimens like pus in which conventional methods may show low sensitivity... Recently in vitro proton MR spectroscopy was evaluated for the diagnosis of TBA... Absence of multiplet of amino acids-lipids at 0.9 ppm seems to be a hallmark of TBA.

No MeSH data available.