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A Case of Disseminated Multidrug-Resistant Tuberculosis involving the Brain.

Jung EK, Chang JY, Lee YP, Chung MK, Seo EK, Koo HS, Choi HJ - Infect Chemother (2016)

Bottom Line: However, her headache and brain lesion worsened.Linezolid was added to intensify the treatment regimen, and steroid was added for the possibility of paradoxical response.Kanamycin was discontinued 6 months after initiation of the treatment; she was treated for 18 months with susceptible drugs and completely recovered.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

ABSTRACT
We report a case of a 23-year-old female immigrant from China who was diagnosed with multidrug-resistant tuberculosis affecting her lung and brain, resistant to the standard first-line therapeutics and streptomycin. She was treated with prothionamide, moxifloxacin, cycloserine, and kanamycin. However, her headache and brain lesion worsened. After the brain biopsy, the patient was confirmed with intracranial tuberculoma. Linezolid was added to intensify the treatment regimen, and steroid was added for the possibility of paradoxical response. Kanamycin was discontinued 6 months after initiation of the treatment; she was treated for 18 months with susceptible drugs and completely recovered. To our knowledge, this case is the first multidrug-resistant tuberculosis that disseminated to the brain in Korea.

No MeSH data available.


Related in: MedlinePlus

(A) Chest radiograph on admission. Bilateral ground glass opacity is visible. (B) After 2 months of anti-tuberculosis treatment, chest radiography shows no active lung lesions. (C) After 18 months of anti-tuberculosis treatment. No residual lesion.
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Figure 1: (A) Chest radiograph on admission. Bilateral ground glass opacity is visible. (B) After 2 months of anti-tuberculosis treatment, chest radiography shows no active lung lesions. (C) After 18 months of anti-tuberculosis treatment. No residual lesion.

Mentions: Laboratory evaluations revealed the following values: white blood cell (WBC) count of 6,760/mm3, with 87.0% neutrophils and 7.8% lymphocytes, platelet count of 84,000/mm3, hemoglobin of 8.8 g/dL, aspartate aminotransferase of 295 IU/L, alanine aminotransferase of 171 IU/L, albumin of 2.3 g/dL, and C-reactive protein level of 7.27 mg/dL. A test for antibody to the HIV was negative. Arterial blood gas analysis showed oxygen pressure level of 50.2 mmHg and 89% oxygen saturation. On chest X-ray, there was diffuse bilateral ground glass opacity (GGO) in both lungs, especially lower lungs (Fig. 1A). Chest computed tomography on the day of admission demonstrated nodular consolidation in right upper lobe, as well as diffuse bilateral GGO and multifocal infiltration in both lungs, which were thought to be atypical pneumonia or pulmonary hemorrhage (Fig. 2).


A Case of Disseminated Multidrug-Resistant Tuberculosis involving the Brain.

Jung EK, Chang JY, Lee YP, Chung MK, Seo EK, Koo HS, Choi HJ - Infect Chemother (2016)

(A) Chest radiograph on admission. Bilateral ground glass opacity is visible. (B) After 2 months of anti-tuberculosis treatment, chest radiography shows no active lung lesions. (C) After 18 months of anti-tuberculosis treatment. No residual lesion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835434&req=5

Figure 1: (A) Chest radiograph on admission. Bilateral ground glass opacity is visible. (B) After 2 months of anti-tuberculosis treatment, chest radiography shows no active lung lesions. (C) After 18 months of anti-tuberculosis treatment. No residual lesion.
Mentions: Laboratory evaluations revealed the following values: white blood cell (WBC) count of 6,760/mm3, with 87.0% neutrophils and 7.8% lymphocytes, platelet count of 84,000/mm3, hemoglobin of 8.8 g/dL, aspartate aminotransferase of 295 IU/L, alanine aminotransferase of 171 IU/L, albumin of 2.3 g/dL, and C-reactive protein level of 7.27 mg/dL. A test for antibody to the HIV was negative. Arterial blood gas analysis showed oxygen pressure level of 50.2 mmHg and 89% oxygen saturation. On chest X-ray, there was diffuse bilateral ground glass opacity (GGO) in both lungs, especially lower lungs (Fig. 1A). Chest computed tomography on the day of admission demonstrated nodular consolidation in right upper lobe, as well as diffuse bilateral GGO and multifocal infiltration in both lungs, which were thought to be atypical pneumonia or pulmonary hemorrhage (Fig. 2).

Bottom Line: However, her headache and brain lesion worsened.Linezolid was added to intensify the treatment regimen, and steroid was added for the possibility of paradoxical response.Kanamycin was discontinued 6 months after initiation of the treatment; she was treated for 18 months with susceptible drugs and completely recovered.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

ABSTRACT
We report a case of a 23-year-old female immigrant from China who was diagnosed with multidrug-resistant tuberculosis affecting her lung and brain, resistant to the standard first-line therapeutics and streptomycin. She was treated with prothionamide, moxifloxacin, cycloserine, and kanamycin. However, her headache and brain lesion worsened. After the brain biopsy, the patient was confirmed with intracranial tuberculoma. Linezolid was added to intensify the treatment regimen, and steroid was added for the possibility of paradoxical response. Kanamycin was discontinued 6 months after initiation of the treatment; she was treated for 18 months with susceptible drugs and completely recovered. To our knowledge, this case is the first multidrug-resistant tuberculosis that disseminated to the brain in Korea.

No MeSH data available.


Related in: MedlinePlus