RESUMO
INTRODUCTION: Heart transplantation is the standard treatment for end-stage heart disease. Despite advances in the field, patients remain under risk of developing complications, including opportunistic infections, such as tuberculosis. We present the unprecedented case of cerebral tuberculoma in a 9-year-old heart transplant recipient. CASE SCENARIO: A 9-year-old female child, who underwent heart transplantation in December 2020, was admitted to the emergency department in September 2021 due to headache and vomiting. She had normal vital signs and a mild left hemiparesis. Laboratory findings included lymphopenia and a low C Reactive Protein and brain images showed expansive lesions. A biopsy of the intracranial lesion was performed and anatomopathological analysis was compatible with tuberculoma. After the diagnosis was established, treatment protocol for neurotuberculosis was initiated, the patient had a satisfactory clinical evolution and was discharged 22 days after admission. DISCUSSION: Clinical manifestation of tuberculosis usually occurs up to 6 months after transplantation, the findings are commonly atypical and symptoms may be mild. We could not find in medical literature any description of the disease in a heart transplant recipient as young as the one presented in this case report. We documented great response to treatment, even though conventional antituberculosis therapy may interfere with immunosuppression. CONCLUSION: Patients in the postoperative period following heart transplantation are at high risk for developing opportunistic infections such as tuberculosis, which may present with atypical symptoms. Therefore the clinician must have a high index of suspicion in order to make the correct diagnosis and promptly start treatment.
Assuntos
Infecções Oportunistas , Tuberculoma Intracraniano , Tuberculose , Feminino , Humanos , Criança , Tuberculoma Intracraniano/diagnóstico , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculoma Intracraniano/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologiaRESUMO
La tuberculosis causada por la bacteria Mycobacterium tuberculosis, se encuentra entre las 10 primeras causas de mortalidad a nivel mundial; la presentación extrapulmonar se produce por siembra vía hematógena o linfática desde un foco primario, correspondiendo a la afectación de sistema nervioso central el 5% de infecciones por TB y se presenta con menor frecuencia en personas inmunocompetentes. Las formas de tuberculosis de SNC son meningitis, tuberculosis espinal y tuberculomas que corresponden al 1% de infecciones por TB. El tratamiento se basa en la terapia antifímica, reservando el manejo neuroquirúrgico para puntuales indicaciones como deterioro neurológico, hidrocefalia o mala respuesta al tratamiento farmacológico.
Tuberculosis, caused by the Mycobacterium tuberculosis bacteria, is among the top 10 cau-ses of mortality worldwide; The extrapulmonary presentation is produced by hematogenous or lymphatic seeding from a primary focus, 5% of TB infections corresponding to central nervous system involvement and occurs less frequently in immunocompetent people. The forms of CNS tuberculosis are meningitis, spinal tuberculosis and tuberculomas that corres- pond to 1% of TB infections. The treatment is based on antifungal therapy, reserving neurosurgical management for specific indications such as neurodeterioration, hydrocephalus or poor response to pharmacological treatment
Assuntos
Humanos , Feminino , Gravidez , Adulto , Tuberculoma Intracraniano , Tuberculose do Sistema Nervoso Central , Imunocompetência , Tuberculoma Intracraniano/cirurgia , Tuberculoma Intracraniano/diagnóstico , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculoma Intracraniano/diagnóstico por imagem , Diagnóstico Diferencial , Manifestações NeurológicasRESUMO
Tuberculosis is a chronic bacterial infection caused by Mycobacterium tuberculosis. Despite advances in treatment, resistant strains and unusual sites of involvement have been diagnosed. We present a case of a 13-year-old patient in treatment for tuberculous meningitis who presented with progressive paraparesis. The MRI showed two intramedullary nodular lesions at T4T6 levels, isointense with annular hyperintensity on T1W, hypointense on T2W, becoming hypointense with ring enhancement after contrast. These characteristics differ from those usually described for intramedullary tuberculomas. Surgical excision was performed, confirming the diagnosis of intramedullary tuberculoma. The formation of intramedullary tuberculomas is rare, with a ratio of two cases per thousand diagnosed with CNS tuberculosis, and the thoracic spine is most frequently affected. The clinical picture is of progressive subacute spinal cord compression, and it may lead to paraplegia. At MRI, the lesion in early stage appears as hypointense rings on T1W and hyperintense on T2W, with homogeneous enhancement after contrast. After the formation of the solid caseous granuloma, it becomes isointense on T1W and hypointense on T2W with homogeneous enhancement after contrast. When the center of the granuloma becomes liquefied, it shows hypointense sign on T1W and hyperintense with peripheral enhancement on T2W. The treatment of choice is medical, with the current protocol including rifampin, isoniazid, pyrazinamide, and ethambutol. Surgery is reserved for cases of progressive neurologic deficits or for diagnostic confirmation. Although benign and potentially curable, intramedullary tuberculoma should be promptly diagnosed and treated to prevent irreversible damage.
A tuberculose é uma infecção bacteriana crônica causada pelo Mycobacterium tuberculosis. Apesar dos avanços no tratamento, cepas resistentes e locais incomuns de envolvimento vêm sendo diagnosticados. Apresentamos o caso de um paciente de 13 anos de idade, em tratamento para meningite tuberculosa que se apresentou com paraparesia progressiva. A ressonância magnética mostrou duas lesões nodulares intramedulares no nível de T4T6, isointensas com bordos hiperintensos em T1, hipointensos em T2, tornando-se hipointensos com realce anelar após contraste. Essas características diferem daquelas usualmente descritas para tuberculomas intramedulares. Foi realizada a excisão cirúrgica, confirmando o diagnóstico de tuberculoma intramedular. A formação de tuberculomas intramedulares é rara, com uma proporção de dois casos por mil diagnosticados com tuberculose do sistema nervoso central (SNC), e a coluna torácica é a mais frequentemente acometida. O quadro clínico é de compressão da medula espinal progressiva subaguda, podendo levar à paraplegia. Na ressonância magnética, a lesão em fase inicial aparece como anéis hipointensos em T1 e hiperintensos em T2, com realce homogêneo após contraste. Após a formação do granuloma caseoso sólido, torna-se isointensa em T1 e hipointensa em T2, com realce homogêneo após contraste. Quando o centro do granuloma torna-se liquefeito, mostra sinal hipointenso em T1 e hiperintenso com realce periférico em T2. O tratamento de escolha é medicamentoso, com o protocolo corrente de rifampicina, isoniazida, pirazinamida e etambutol. A cirurgia é reservada para os casos de déficit neurológico progressivo ou para confirmação diagnóstica. Embora benigna e potencialmente curável, deve ser diagnosticada e tratada para evitar danos irreversíveis.
Assuntos
Humanos , Masculino , Adolescente , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/terapia , Tuberculoma Intracraniano/diagnósticoRESUMO
Objetivos: Describir las características diagnosticas epidemiológicas, clínicas, de LCR, imagenológicas de tuberculosis intracraneal (TBC Meníngea, Tuberculoma) en hospitalizados del Servicio de Neurología del Hospital Nacional Guillermo Almenara Irigoyen 2008-2012. Materiales y Métodos: Se seleccionó la historia de todos los pacientes hospitalizados en el Servicio de Neurología del Hospital Nacional Guillermo Almenara Irigoyen entre los años 2008 y 2012 con diagnóstico de tuberculosis intracraneal confirmada o sospechosa con un número total de 26 casos. Se obtuvo datos de filiación, antecedentes epidemiológicos, historia de enfermedad, examen neurológico de los 26 pacientes; estudios en LCR: bioquímicos y citoquímicos en 25 pacientes, bk en 20 pacientes, ADA en 20 pacientes, PCR en 8 pacientes y cultivo en 7 pacientes; a los 26 casos se realizó TAC de encéfalo, y a 17 RMN de encéfalo. Resultados: En el Servicio de Neurología del Hospital Nacional Guillermo Almenara referente de la red Almenara se hospitalizaron 26 casos de Tuberculosis Intracraneal (1.47 por ciento de hospitalizados en el Servicio de Neurología) del año 2008 al 2012, de los cuales 19 casos (73.07 por ciento) fueron Tuberculoma cerebral y 07 casos (26.93 por ciento) Meningoencefalitis Tuberculosa (MEC TBC); 17 casos (65.381 por ciento) fueron de sexo masculino y 9 (35.62 por ciento) de sexo femenino, la mayoría estuvieron comprendidos entre el segmento 26 a 40 años con 14 (54.85 por ciento) casos siendo predominante tanto para tuberculoma cerebral 11 (57.89 por ciento), como para MEC TBC 03 (42.86 por ciento); la mayoría provinieron de la Red Almenara 20 (76.91 por ciento) a diferencia de otros 6 casos (23.08 por ciento) que provinieron de otras redes; el tipo de seguro en su mayoría fue obligatorio (principal aportante activo del seguro social) con 15 (57.68 por ciento) pacientes. De los antecedentes epidemiológicos 08 pacientes (30.77 por ciento) tuvieron contacto familiar de tuberculosis...
Objectives: Describe diagnostic epidemiological, clinical, CSF, imaging of intracranial tuberculosis (TBC Meningeal, Tuberculoma) in hospitalized Neurology Service of the National Hospital Guillermo Almenara Irigoyen 2008-2012. Materials and methods: The history of all patients hospitalized in the Neurology Service of Guillermo Almenara Irigoyen National Hospital between 2008 and 2012 confirmed or suspected diagnosis of a total number of 26 cases intracranial tuberculosis was selected. Personal data, epidemiological history, history of disease, neurological examination of 26 patients was obtained; CSF studies: Biochemical and cytochemical in 25 patients, 20 patients bk, ADA in 20 patients, 8 patients PCR and culture in 7 patients; the 26 cases of brain CT scan was performed, and 17 NMR brain. Results: In the Neurology Service of the Guillermo Almenara National Hospital, Almenara benchmark of 26 cases of Tuberculosis Intracranial (1.47 per cent of hospitalized in the Neurology Service) they were hospitalized 2008 to 2012, of which 19 cases (73.07 per cent) were Tuberculoma cerebral and 07 cases (26.93 per cent) meningoencephalitis Tuberculous (TBC MEC); 17 cases (65.381 per cent) were males and 9 (35.62 per cent) were female, most were between the segment 26 to 40 years with 14 (54.85 per cent) cases being predominant both cerebral tuberculoma 11 (57.89 per cent) and for MEC TBC 03 (42.86 per cent); most carne from Beacon Red 20 (76.91 per cent) unlike another 6 cases (23.08 per cent) that carne from other networks; the type of insurance was mostly compulsory (primary active contributor of social insurance) 15 (57.68 per cent) patients. The epidemiological history of 08 patients (30.77 per cent) had household contact with tuberculosis; 03 (11.54 per cent) patients had associated immune suppression, with only 3 cases of TBC MEC (MEC 42.86 per cent). The most common general symptoms were headache in 20 cases (76.92 per cent), followed by nausea and vomiting in...
Assuntos
Masculino , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Tuberculoma Intracraniano/diagnóstico , Tuberculoma Intracraniano/epidemiologia , Tuberculose do Sistema Nervoso Central , Estudos Observacionais como Assunto , Estudos Retrospectivos , Relatos de CasosRESUMO
BACKGROUND: Tuberculosis is a major health concern in Mexico, especially among the native population. Tuberculomas are a frequent and severe complication of pediatric tuberculosis, these are observed as tumors in neuroimaging studies but are often not diagnosed adequately. CASE PRESENTATION: We present a case of a 12-year-old native Mexican girl Huichol ethnicity diagnosed with a large posterior fossa tuberculoma found by imaging. This tuberculoma was surgically removed. Histopathologic examination and staining with hematoxylin and eosin, and Ziehl-Neelsen techniques of the surgical specimen were performed. Cerebrospinal fluid was analyzed by using the newly available Xpert® MTB/RIF assay (Cepheid, Sunnyvale CA, USA). Granulomatous inflammation with central caseous necrosis surrounded by edematous brain with reactive gliosis and acid-fast bacilli were revealed on histopathologic analysis. Mycobacterium tuberculosis DNA susceptible to rifampicin was detected in the patient's cerebrospinal fluid and the patient was started on anti-tuberculosis treatment. The girl continued to show severe neurologic damage despite surgery and anti-tuberculosis treatment, and she eventually died of respiratory complications. CONCLUSION: Our case highlights the need for early confirmation of tuberculoma diagnosis by molecular assay so that timely treatment can be initiated to prevent severe brain damage. Furthermore, it emphasizes the need to consider tuberculomas in the differential diagnosis of children with neurologic symptoms living in areas of high tuberculosis incidence and those belonging to native populations in developing countries.
Assuntos
Antituberculosos/uso terapêutico , Etnicidade , Tuberculoma Intracraniano/diagnóstico , Criança , Feminino , Humanos , Imageamento por Ressonância Magnética , México , Tuberculoma Intracraniano/tratamento farmacológicoRESUMO
A solitary tuberculous brain lesion (STBL) can be difficult to distinguish from a glioma, metastasis or other infectious disease, especially from a pyogenic brain abscess. We analyzed the clinical characteristics, diagnostic procedures and outcomes of 24 patients with STBL diagnosed in three centers from France, India and Mexico. We also reviewed 92 STBL cases previously reported in the literature. General symptoms were found in 54% of our patients, including enlarged lymph nodes in 20%. Cerebrospinal fluid was typically abnormal, with lymphocytic pleocytosis and a high protein level. The lung CT scan was abnormal in 56% of patients, showing lymphadenopathy or pachipleuritis. Brain MRI or CT was always abnormal, showing contrast-enhanced lesions. Typically, MRI abnormalities were hypointense on T1-weighted sequences, while T2-weighted sequences showed both a peripheral hypersignal and a central hyposignal. The diagnosis was documented microbiologically or supported histologically in 71% of cases. Clinical outcome was good in 83% of cases.
Assuntos
Tuberculoma Intracraniano/epidemiologia , Adolescente , Adulto , Idoso , Antituberculosos/uso terapêutico , Abscesso Encefálico/diagnóstico , Neoplasias Encefálicas/diagnóstico , Comorbidade , Diagnóstico Diferencial , Feminino , Febre/etiologia , França/epidemiologia , Glioma/diagnóstico , Cefaleia/etiologia , Humanos , Índia/epidemiologia , Imageamento por Ressonância Magnética , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Marrocos/etnologia , Mycobacterium tuberculosis/isolamento & purificação , Avaliação de Sintomas , Tomografia Computadorizada por Raios X , Tuberculoma Intracraniano/diagnóstico , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculoma Intracraniano/patologia , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/epidemiologia , Adulto JovemRESUMO
Cerebral tuberculoma is a rare cause of intracranial mass. In Latin America and Colombia where tuberculosis is endemic, it represents between 5 and 30% of brain tumours. A 53-year-old Colombian woman was admitted to a third-level hospital in Cali, Colombia, after reporting loss of consciousness, headache, paresthesia, and flight of ideas for a two-week period. Imaging studies showed a left frontal mass of malignant appearance whose first possible diagnosis was metastatic neoplasia or glioma. With the initial results, absence of history of chronic infectious diseases and a history of thyroidectomy, a surgical procedure was carried out and a histopathological and molecular evaluation was conducted. The pathology report noted necrotizing granulomatous inflammation and tissue staining and molecular tests for detection of M. tuberculosis were positive and the patient was managed with anti-tubercular treatment. Intracranial masses are frequently targeted as a malignant neoplastic disease for surgical treatment. Considering an infectious etiology must be a diagnostic option.
Assuntos
Neoplasias Encefálicas/diagnóstico , Tuberculoma Intracraniano/diagnóstico , Encéfalo/patologia , Colômbia , Diagnóstico Diferencial , Feminino , Cefaleia/microbiologia , Humanos , Inflamação/diagnóstico , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Mycobacterium tuberculosis/genética , Necrose , Reação em Cadeia da Polimerase , Tomografia Computadorizada por Raios X , Tuberculoma Intracraniano/microbiologiaRESUMO
Brain tuberculomas account for 10-20% of space occupying brain lesions in developing countries. Most lesions are observed at time of tuberculosis diagnosis or soon after starting treatment. We herein describe a 32 year-old patient with a 14-month history of headache and progressive visual loss. Her past medical history revealed pulmonary tuberculosis treated eight years before. A brain MRI showed a T1- and T2-weighted isointense contrast-enhancing lesion in the optic chiasm. A presumptive diagnosis of optochiasmatic tuberculoma was made and isoniazid, rifampin, pyrazinamide, and ethambutol were started. Despite treatment, the patient evolved to blindness. The prompt recognition of this condition is extremely important since the presence of optochiasmal enhancement is associated with blindness in patients with tuberculosis.
Assuntos
Quiasma Óptico , Tuberculoma Intracraniano/diagnóstico , Adulto , Cegueira/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Recidiva , Tuberculoma Intracraniano/sangue , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculose Pulmonar/complicaçõesRESUMO
Brain tuberculomas account for 10-20% of space occupying brain lesions in developing countries. Most lesions are observed at time of tuberculosis diagnosis or soon after starting treatment. We herein describe a 32 year-old patient with a 14-month history of headache and progressive visual loss. Her past medical history revealed pulmonary tuberculosis treated eight years before. A brain MRI showed a T1- and T2-weighted isointense contrast-enhancing lesion in the optic chiasm. A presumptive diagnosis of optochiasmatic tuberculoma was made and isoniazid, rifampin, pyrazinamide, and ethambutol were started. Despite treatment, the patient evolved to blindness. The prompt recognition of this condition is extremely important since the presence of optochiasmal enhancement is associated with blindness in patients with tuberculosis.
Tuberculomas cerebrais são responsáveis por 10-20% das lesões parenquimatosas em países em desenvolvimento. A maioria destas lesões é observada ao diagnóstico de tuberculose ou logo após o início do tratamento. Descrevemos um caso de uma paciente de 32 anos com história de 14 meses de evolução de perda visual progressiva e cefaleia. A história patológica revelou tuberculose pulmonar 8 anos antes. A ressonância magnética do crânio mostrou uma lesão isointensa nas sequências T1 e T2 captantes de contraste no quiasma óptico. Fizemos o diagnóstico presuntivo de tuberculoma ótico-quiasmático e inciamos isoniazida, rifampicina, pirazinamida e etambutol. Apesar do tratamento, a paciente evoluiu para amaurose bilateral. O rápido diagnóstico desta condição é extremamente importante já que a presença de captação de contraste está associada à amaurose em pacientes com tuberculose.
Assuntos
Adulto , Feminino , Humanos , Quiasma Óptico , Tuberculoma Intracraniano/diagnóstico , Cegueira/etiologia , Imageamento por Ressonância Magnética , Recidiva , Tuberculoma Intracraniano/sangue , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculose Pulmonar/complicaçõesRESUMO
Objetivos. Mostrar nuestra casuística de pacientes con diagnóstico de tuberculosis intracraneana y describir los diferentes tipos de lesiones documentadas en Resonancia Magnética (RM) que caracterizan a esta entidad. Materiales y Métodos. Para el presente trabajo fueron seleccionados, de forma retrospectiva, 20 pacientes con hallazgos positivos de tuberculosis intracraneana. Doce eran de sexo masculino y 8 de sexo femenino, conun rango etario de 8 meses a 49 años de edad (edad media: 21 años). El diagnóstico clínico fue realizado con punción lumbar y cultivo de LCR. Once pacientes presentaron serología positiva para VIH. Las RM fueron realizadas en resonadores de 0.5T y 1.5T, complementadas en dos casos con Tomografía Computada (TC) de cerebro. A dos pacientes se les realizó difusión (DWI) y a un paciente espectroscopía. Resultados. Del total de pacientes (n=20), 14 presentaron compromiso subaracnoideo en la convexidad y 13 compromiso subaracnoideo cisternal basal (afectación leptomeníngea). En 13 se observaron tuberculomas y 11 presentaron angeítis de grandes vasos; mientras que 7 tuvieron angeítis de pequeños vasos, 7 hidrocefalia, 6 infartos parenquimatosos y 1 afectación paquimeníngea. Quince pacientes tenían lesiones combinadas.Conclusión. La localización más frecuente de neurotuberculosis en esta serie fue meníngea con compromiso leptomeníngeo (14 pacientes con afectación subaracnoidea, seguido de afectación cisternal en 13 pacientes) y sólo en un caso fue paquimeníngea. La manifestación parenquimatosa más frecuente fue el tuberculoma (granulomas tuberculosos) con 13 casos. De estos, 5 presentaron un patrón miliar y sólo uno comportamiento pseudotumoral...