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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

Hematoxylin and Eosin stain of brain biopsy at frontal lobe subcortical white matter lesion. Chronic granulomatous inflammation is visible in the arrow mark.
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Figure 5: Hematoxylin and Eosin stain of brain biopsy at frontal lobe subcortical white matter lesion. Chronic granulomatous inflammation is visible in the arrow mark.

Mentions: After 20 days of treatment with second line anti-TB medication, on hospital day 93, the headache reappeared, the frontal brain lesion enlarged and surrounding edema worsened in brain CT (Fig. 3B). The stereotactic brain biopsy was performed to confirm CNS TB for brain mass. The CSF analysis was normal except mildly elevated protein of 99 mg/dL. The CSF was negative for TB-PCR nor AFB culture. The biopsy showed only granulomatous necrotic tissue positive by TB-PCR, suggestive CNS-TB (Fig. 5). The brain tissue did not show any positive micro-organisms with Ziehl-Neelsen, Periodic acid-Schiff, Gomori's methanamine silver, and Gram stain. But culture for brain tissue was not performed. Sputum culture was negative since hospital day 22, there was no sign of pulmonary tuberculosis. The dexamethasone 10 mg/d was started for the possibility of paradoxical enlargement of intracranial tuberculoma. Linezolid was added to intensify the regimen, and the headache improved without neulorogic sequelae. Kanamycin was stopped after 6 month-treatment due to pain of injection site. She was treated for 18 months after initial TB diagnosis with susceptible drugs, and completely recovered. The chest X-ray was completely resolved (Fig. 1C) and the brain lesions on brain CT were stable without enhancing lesion (Fig. 3C).


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)

Hematoxylin and Eosin stain of brain biopsy at frontal lobe subcortical white matter lesion. Chronic granulomatous inflammation is visible in the arrow mark.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Hematoxylin and Eosin stain of brain biopsy at frontal lobe subcortical white matter lesion. Chronic granulomatous inflammation is visible in the arrow mark.
Mentions: After 20 days of treatment with second line anti-TB medication, on hospital day 93, the headache reappeared, the frontal brain lesion enlarged and surrounding edema worsened in brain CT (Fig. 3B). The stereotactic brain biopsy was performed to confirm CNS TB for brain mass. The CSF analysis was normal except mildly elevated protein of 99 mg/dL. The CSF was negative for TB-PCR nor AFB culture. The biopsy showed only granulomatous necrotic tissue positive by TB-PCR, suggestive CNS-TB (Fig. 5). The brain tissue did not show any positive micro-organisms with Ziehl-Neelsen, Periodic acid-Schiff, Gomori's methanamine silver, and Gram stain. But culture for brain tissue was not performed. Sputum culture was negative since hospital day 22, there was no sign of pulmonary tuberculosis. The dexamethasone 10 mg/d was started for the possibility of paradoxical enlargement of intracranial tuberculoma. Linezolid was added to intensify the regimen, and the headache improved without neulorogic sequelae. Kanamycin was stopped after 6 month-treatment due to pain of injection site. She was treated for 18 months after initial TB diagnosis with susceptible drugs, and completely recovered. The chest X-ray was completely resolved (Fig. 1C) and the brain lesions on brain CT were stable without enhancing lesion (Fig. 3C).

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