Bilateral interstitial keratitis in a patient with presumed brain tuberculoma / Ceratite intersticial bilateral em um paciente com tuberculoma cerebral presumido

ABSTRACT Interstitial keratitis is an inflammation of the corneal stroma without epithelium or endothelium involvement. The underlying causes are mostly infectious or immune mediated. Brazil has one of the highest incidence rates of tuberculosis in the world. Tuberculosis is considered one of the causes of interstitial keratitis. Malnutrition and anemia are risk factors of the disseminated disease. This is a case report of a 10-year-old child who presented with decreased visual acuity and a clinical diagnosis of bilateral interstitial keratitis and sclero-uveitis. The patient had been treated with topical steroids with partial improvement. Examinations revealed severe iron deficiency anemia, negative serologies for human immunodeficiency virus and syphilis, positivity for cytomegalovirus- and herpes simplex-specific IgG, and purified protein derivative of 17 mm. During the follow-up, the patient presented with tonic-clonic seizures, and magnetic resonance imaging findings suggested a central nervous system tuberculoma. Interstitial keratitis improvement was observed after specific tuberculosis treatment. This is the first case report describing the association of interstitial keratitis and central nervous system tuberculoma.

RESUMO A ceratite intersticial é uma inflamação do estroma corneano sem envolvimento epitelial ou endotelial causada principalmente por doenças infecciosas e imunomediadas. O Brasil tem altas taxas de tuberculose que deve ser lembrada como causa de ceratite intersticial. Desnutrição e anemia são fatores de risco da forma disseminada da tuberculose. Este é um relato de uma criança de 10 anos com redução de acuidade visual e diagnóstico clínico de ceratite intersticial bilateral e esclerouveíte. O paciente obteve melhora parcial da ceratite com corticoide tópico. Exames laboratoriais mostraram anemia ferropriva grave, sorologias negativas para HIV e sífilis; IgM negativo e IgG positivo para citomegalovírus e herpes simplex e PPD positivo (17 mm). Ele evoluiu com crises tônico-clônicas e a ressonância nuclear magnética revelou tuberculoma do sistema nervoso central. A melhora da ceratite intersticial foi observada após tratamento para tuberculose. Este é o primeiro caso que descreve a associação de ceratite intersticial e tuberculoma do sistema nervoso central.

A Series of Ocular Tuberculosis Cases from A Rural Tertiary Care Center in West Bengal

Tuberculosis in Eye can have diverse presentations leads to diagnostic difficulty. If no extra-ocular tubercular lesions are found then it becomes a challenge to diagnose & treat. Here authors present 6 cases of Ocular Tuberculosis without any associated extra-ocular tubercular lesions. One case of tubercular anterior uveitis, eales disease, solitary Choroidal Tuberculoma, bilateral multiple Choroidal Tuberculoma, multifocal & serpiginous like Choroiditis are presented here. All of them were resolved with first line anti-tubercular regimen and corticosteroids. Authors recommend initial visual assessment for all Tuberculosis cases to diagnose & treat hidden cases of Ocular Tuberculosis which may be sight threatening.

Masa pulmonar como manifestación primaria de tuberculosis en pediatría: reporte de un caso / Pulmonary tuberculosis presenting as a lung mass in children: case report

La tuberculosis es una de las principales causas infecciosas de muerte en el mundo y es endémica en Argentina. La mayoría de los casos de tuberculosis son de localización pulmonar; el tuberculoma una complicación infrecuente. Se describe un caso clínico de presentación pulmonar atípica de tuberculosis. Se trata de una niña de 15 meses, previamente sana, derivada a neumología por fiebre, mal progreso de peso e imagen persistente por 2 meses en la radiografía de tórax a pesar de haber recibido antibioticoterapia. Antecedente de contacto estrecho con persona sintomática respiratoria. Se internó para estudio, mostró una PPD de 13 mm y una masa voluminosa heterogénea en el lóbulo superior izquierdo en la tomografía computada de tórax. Se realizaron tres lavados gástricos y toracoscopia exploratoria con biopsia pulmonar con rescate de Mycobacterium tuberculosis en cultivos. Se diagnosticó tuberculoma pulmonar y realizó tratamiento estándar con fármacos antituberculosos con evolución favorable.

Tuberculosis is one of the main causes of death due to infection around the world. Although tuberculosis frequently involves lung parenchyma, tuberculoma is a rare complication. We describe an atypical pulmonary presentation of tuberculosis. A 15-month-old girl, previously healthy, was referred to the pulmonology department due to fever, poor weight gain, and a 2-months persistent lung image on chest x-ray despite antibiotic therapy. She had been in frequent contact with a respiratory symptomatic subject. She was admitted to the hospital with a TST of 13 mm and a heterogeneous bulky mass in the left upper lobe at chest computed tomography. Three gastric lavages were done and the patient underwent exploratory thoracoscopy and lung biopsy, with positive cultures for Mycobacterium tuberculosis. The diagnosis of pulmonary tuberculoma was confirmed, and the patient received standard anti- tuberculosis therapy with a favorable evolution.

A study of clinical profile and treatment outcomes in CNS tuberculoma

Worldwide, around 10 million people fall sick every year because of Tuberculosis (TB). In India, the incidence is 2.69 million cases. Central nervous system Tuberculosis (CNS TB), which is one of the most deadly forms of tuberculosis (TB) mainly manifests as TB Meningitis followed by Tuberculoma, Tubercular abscess and other forms. CNS TB is seen in 5 to 10% of extra-pulmonary TB cases, and accounts for 1% of all TB cases and has the highest mortality. They usually present with symptoms such as headache and seizures. They may have other signs and symptoms based on the size and the location of the lesions. The advent of modern technology such as CT, MRI scans helped to diagnose early. Diagnosis is established by CT/MRI Brain, where a granulomatous lesion with/without perilesional edema is seen. MR Spectroscopy brain is indicated when the diagnosis is doubtful. Presence of lipid peak on MR Spectroscopy is diagnostic of CNS Tuberculomas. Medical management is adequate and there is no role for surgery. A course of ATT for 6 months along with corticosteroids is adequate. Addition of corticosteroids is necessary to reduce the paradoxical response; it also reduces the size of the lesion and perilesional edema. Anti epileptic drugs are not necessary. CNS Tuberculoma is curable if treated properly.

Delayed diagnosis of disseminated tuberculosis in pregnancy: a case report

Miliary tuberculosis (TB) is a lethal form of TB, if left untreated. Miliary TB accounts for <2% of all cases of TB in immunocompetentindividuals. Intracranial tuberculoma is a rare manifestation ofMycobacterium tuberculosis(MTB), seen in only 1% of TB patients. It can occur as single or multiple lesions, most commonly located in the frontal and parietal lobes. Clinical features mimicthat of any space-occupying lesion in the brain.In pregnant women, diagnosis of TBmay be delayed by the non-specific nature of early symptoms and because they are often attributed to pregnancy.Here we report one such case where the diagnosis of TBwas delayed due to the non-specific nature of her symptoms in ante-natal period.

CNS Tuberculosis

Tuberculosis can involve almost any organ of the body. In the Central Nervous System (CNS) it can cause meningitis, tuberculoma, abscess,spondylitis, arachnoiditis, myeloradiculitis or other manifestations. Around 10% of all patients with tuberculosis have CNS involvement. Tuberculosis is rampant in the developing world and has reemerged as a major public health menace with the HIV pandemic. Compared with HIV-negative individuals, HIVpositive individuals with TB are 5 times more likely to have CNS involvement. Laboratory confirmation of CNS TB is difficult and hence empirical treatment has to be initiated as early as possible based on clinical and radiological features. In this article,we review the CNS manifestations of tuberculosis and their diagnosis and treatment

Unilateral choroidal tuberculoma as an initial manifestation of presumed ocular tuberculosis: a case report / Tuberculoma coroidal unilateral como manifestação inicial de tuberculose ocular presumida: relato de caso

ABSTRACT Choroidal tuberculomas are present in patients with ocular tuberculosis. They usually occur in a patient with previous history of tuberculosis, and are rarely the initial presentation, with no prior systemic manifestations. We present a patient with unilateral choroidal tuberculoma as the initial presentation of presumed ocular tuberculosis, which enabled earlier initiation of treatment.

RESUMO Os tuberculomas de coroide apresentam-se em pacientes com tuberculose ocular. Geralmente, ocorrem em indivíduos com história prévia de tuberculose e raramente têm apresentação inicial sem manifestações sistêmicas anteriores. Relatamos o caso de um paciente com tuberculoma de coroide unilateral com apresentação inicial de tuberculose ocular presumida, permitindo o início mais precoce do tratamento.

Tuberculosis: a great masquerader

Central nervous system tuberculosis caused by Mycobacterium tuberculosis is the most severe form of tuberculosis, accounting for 1% of all TB cases. Intracranial tuberculosis can present as Tuberculous meningitis, Tuberculous encephalopathy, Tuberculous vasculitis, CNS tuberculomas and Tuberculous brain abscess. Here authors present a case of a 10-year-old girl who presented with insidious onset of early morning vomiting, excessive sleepiness with classical neuroimaging findings of intracranial tuberculosis. Authors emphasise that intracranial tuberculoma should be considered in the differential diagnosis of any intracranial space-occupying lesion with or without pulmonary involvement.

Brain Tuberculoma as a Differential Diagnosis of Single Intracranial Lesion: Case Report

Tuberculosis (TB) of the central nervous system (CNS) is considered one of the most severe forms of presentation of the disease. Although only 1% of TB cases involve the CNS, these cases represent around between 5 and 15% of extrapulmonary forms.1,2 Tuberculous meningitis (TBM) is the most frequent form of CNS TB. The granulomas formed in the cerebral tuberculoma may cause hydrocephalus and other symptoms indicative of a CNS mass lesion. In the absence of active TB or TBM, the symptoms may be interpreted as indicative of tumors.3,4 The prognosis is directly related to the early diagnosis and proper treatment installation.5 We report the case of a patient with intracranial hypertension syndrome, expansive mass in the parieto-occipital region, accompanied by a lesion in the rib, initially thought to be a metastatic lesion, although posteriorly diagnosed as a cerebral tuberculoma.

Síndrome de Otelo secundario a tuberculoma cerebral: a propósito de un caso / Othello Syndrome Secondary to Cerebral Tuberculoma: A Case Report

RESUMEN Introducción: El síndrome de Otelo, epónimo del personaje de Shakespeare, es un término diagnóstico transnosológico que designa un cuadro caracterizado por delirios de infidelidad respecto a la pareja que, por consiguiente, puede acarrear actitudes celotípicas y conductas violentas hacia ella. En su forma pura, corresponde al trastorno delirante de infidelidad, pero también puede ser secundario a organicidad cerebral y a consumo de drogas. Métodos: Reporte de caso y revisión no sistemática de la literatura relevante. Presentación del caso: Varón de 26 arios con antecedente de consumo de drogas y víctima de maltrato infantil, 3 años antes había sufrido crisis convulsivas tónico-clónicas e hipertensión intracraneal, por lo que se sometió a una craneotomía, en la que se halló un tuberculoma cerebral frontal derecho. Tras un lapso, comenzó con delirios de infidelidad y conductas violentas hacia su pareja. Revisión de la literatura: Los celos delirantes se asocian, como otros delirios, a lesiones del lóbulo frontal derecho. Pese a la elevada y creciente prevalencia mundial de tuberculosis, no se han publicado casos de síndrome de Otelo secundario a tuberculoma cerebral. Conclusiones: El síndrome de Otelo, aunque no es la principal causa de violencia doméstica, puede asociarse con manifestaciones particularmente violentas y ser secundario a tuberculoma cerebral. Este es el primer caso de tal índole que se publica.

ABSTRACT Introduction: Othello syndrome, an eponym of Shakespeare's character, is a transnosological diagnostic term that designates a clinical picture characterised by the presence of delusions of infidelity with respect to a partner and that, consequently, can lead to typical jealousy attitudes and violent behaviour towards the partner. In its pure form, it corresponds to delusional disorder of infidelity, but it may also be secondary to brain organicity and drug use. Methods: Case report and non-systematic review of the relevant literature. Case presentation: A 26-year-old man, with a history of drug abuse and a victim of domestic violence as a child, presented with tonic-clonic seizures and intracranial hypertension three years ago, for which he underwent a craniotomy with the finding of a right frontal cerebral tuberculoma. After a lapse, he developed a clinical picture of delusions of infidelity regarding his partner and violent behaviour towards her. Literature review: Delusional jealousy is associated, like other delusions, with lesions of the right frontal lobe. Despite the high and growing prevalence of tuberculosis worldwide, there are no reported cases of Othello syndrome secondary to cerebral tuberculoma in the literature. Conclusion: Othello syndrome, although not the main cause of domestic violence, can be associated with particularly violent manifestations and be secondary to cerebral tuberculoma. This is the first published case of its kind.

Seizures in a child with tuberculomas: case report

Central tuberculomas, occurring because of the haematogenous spread of' M. tuberculosis, can present variably with the symptoms ranging from headache, decreased level of consciousness, neck stiffness to altered mental status, seizures and focal deficits. Diagnostic investigations include but are not limited to CSF analysis, MRI Brain, CT head, and AFB smear, mycobacterial cultures or CBNAAT of the CSF sample. Magnetic resonance spectroscopy can help distinguishing the tuberculoma from its differentials by showing a peculiar lipid peak. Treatment with the antituberculosis drugs over a prolonged period of time along with dexamethasone usually shows significant clinical improvement. Authors present to you the case report of an 8 year old boy who presented to the pediatric emergency with generalized tonic clonic seizures and was subsequently detected with the tuberculoma with the help of MRI Brain and CBNAAT (cartridge based nucleic acid amplification test) of CSF sample. The objective of this case report is to discuss the symptoms, pathogenesis, detection and management of tuberculomas, which are still quite common in the developing countries and if left untreated are associated with high morbidity and mortality.

Starry sky appearance of tuberculoma

CNS tuberculosis accounts for only 10% of all cases of tuberculosis, carries a high mortality and morbidity. Tuberculoma of the brain is an important clinical entity. The main challenge in the management of brain tuberculoma is its diagnosis. Hereby, referring case of a 12 years old male child who presented with clinical picture of tuberculosis but radiologically NCC, hence posing a diagnostic dilemma as clinically it was in the favor of tuberculosis whereas radiologically inclination was towards neurocysticercosis. Based on clinical manifestations it was suggestive of meningitis, CSF picture was suggestive of hypoglycorrhachia. CT chest showed miliary pattern and neuroimaging showing multiple ring enhancing lesions. High index of clinical suspicion is required to make a diagnosis and evaluation with reports.

The significance of T-SPOT.TB and erythrocyte sedimentation rate test in the diagnosis of simple pulmonary nodules in Xinjiang / 中国胸心血管外科临床杂志

@#Objective    To investigate the diagnostic value of tuberculosis T cell spot test (T-SPOT.TB) and erythrocyte sedimentation rate (ESR) test in the diagnosis of simple pulmonary nodules in Xinjiang. Methods    A retrospective analysis of 72 patients with asymptomatic simple pulmonary nodules in the Department of Thoracic Surgery, the First Affiliated Hospital of Xinjiang Medical University from October 2017 to July 2019 was performed. According to the pathological results, the patients were divided into a tuberculoma group [n=23, including 14 males and 9 females, aged 37-84 (56.91±12.73) years] and a lung cancer group [n=49, including 31 males and 18 females, aged 34-83 (61.71±10.15) years]. The predictive value of T-SPOT.TB and ESR results for the diagnosis of simple pulmonary nodules was evaluated. Results    The positive rate of T-SPOT.TB in the tuberculoma group (69.60%) was higher than that in the lung cancer group (42.90%) (χ2=5.324，P=0.021), with a sensitivity of 69.56% and specificity of 57.14%; the positive ESR was 47.80%in the tuberculoma group and 59.20% in the lung cancer group, and no statistical difference was found between the two groups (χ2=0.981, P=0.322), with a sensitivity of 47.82% and specificity of 40.81%; the area under receiver operating characteristic curve (AUC) was 0.618, the 95% confidence interval of AUC was (0.479, 0.758), and the Youden’s index was 0.267 with a sensitivity of 69.60% and specificity of 57.10%. Difference in the T-SPOT.TB and ESR test results was statistically significant (χ2=4.986, P=0.026), but the correlation between the tests was weak with a Pearson contingency coefficient of 0.199. ESR results in patients with different ages were statistically different (χ2=7.343, P=0.025), but the correlation between age and ESR results was weak with a Pearson contingency coefficient of 0.239; T-SPOT.TB results in patients with different ages were not statistically different (χ2=0.865, P=0.649), and the correlation between age and ESR results was weak with a Pearson contingency coefficient of 0.084. Conclusion    The diagnostic value of T-SPOT.TB and ESR tests is small in the diagnosis of simple pulmonary nodules.

Urinary Incontinence In Women: Primary Healthcare Physicians' Knowledge And Practice In The Eastern Province, Saudi Arabia

Background:Morocco is one of the countries that has high burden of all forms of tuberculosis. The occurrence of this condition, though previously reported only in the developing world. Commonly presented as tubercular meningitis, post-tubercular meningitis hydrocephalus, and much more rarely as space-occupying lesions known as tuberculomas. Cerebral tuberculomas are a rare and serious form of tuberculosis (TB) due to the haematogenous spread of Mycobacterium Tuberculosis (MT).Objective :to review the clinical, epidemiological, computerized tomography and/or magnetic resonance imaging features, and treatment of intracranial tuberculoma.Methods:retrospective review of 25 patient's medical records treated for brain tuberculomas that had computerized tomography and/or magnetic resonance imaging brain scans and confirmed histopathological diagnoses, at Hassan II Hospital between January 2008 and June 2018.Results:in 25 cases imaging was available for review and were included in the study . There were 15 males and 10 females with age range being 2 to 65 years and with the Median age being 13 years. Twenty patients had computerized tomography and five patients had magnetic resonance imaging. Seizure 15/25 (60%) and headache 11/25 (44%) were the commonest presentation. Solitary or confluent large lesions were seen in 12/25 (48%) of patients. 14/25 (56%) of the lesions had their size between 2 cm and 5 cm. Majority of the lesions 15/25 (60%) were in the frontal and parietal lobes. The lesions were isodense on CTin 18/25 (72%) of the pre-contrast studies and 21/25 (84%) showed ring or rim enhancement after intravenous administration of the contrast medium.Conclusion:Tuberculoma, more frequently, presented with non-specific clinical findings and chronic seizure disorder and commonly occurred in young patients and often seen infratentorialy. It is often complicated with hydrocephalus in the pediatric age group. Computerized tomography scan and/or magnetic resonance imaging features are not different from reports from other countries

Tuberculoid Granuloma in the Brainstem: Case Report

Meningitis or meningoencephalitis are the most common presentations of Koch bacilli infection on the central nervous system (CNS), especially in immunosuppressed patients, in whom the bacilli normally reaches the meninges and the cerebral parenchyma.. A least common pathological presentation is the tumoral growth pattern disease known as tuberculoma. This pathological entity is more common in the cerebral hemispheres and is rarely located in the brainstem. The present case report describes a case of a 55-year-old patient under regular antiretroviral therapy who was hospitalized with signs of brainstem and cerebellar disturbances. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain showed an exophytic lesion in the dorsal region of the pons. The patient underwent total resection of the lesion and the histopathologic analysis was consistent with a tuberculoma.

Clinical profile and evaluation of new onset seizure in adults

Background: Seizures beginning in adult life are likely to be an identifiable cause as compared to those beginning in childhood which is more likely to be idiopathic. Aim and objectives: To study the clinical profile and analyze the etiological agents of New Onset Seizures. Materials and methods: This descriptive study was done in the Government HQRS Hospital and AIMSR, Chittoor, Andhra Pradesh to know the various etiologies in patients presented with newonset seizures. In these cases history and clinical examination and special investigations like CT brain, MRI brain, EEG, Serology, CSF analysis were done to find out the etiology. Results: Out of 100 patients, 55% were males, 45%were females with male to female ratio of 1.2:1. The majority of males were in 2nd decade and females were in 4th decade. Patients' age ranged from 18 years to 80 years, with the mean of 40.11 years with 77% of the patients were in the below 50 years. Alcohol withdrawal was the leading cause of seizures which account for 34% followed by idiopathic seizures (29%), neuro infection (16%), CVA 12% and metabolic (9%). Conclusion: Alcohol withdrawal is the most common cause of seizure in new-onset seizure patients who coming to Government HQRS Hospital and AIMSR Chittoor, Andhra Pradesh

Sural Nerve Tuberculoma: A Case Report / 대한족부족관절학회지

Nearly one third of the world's population have active or latent tuberculosis, resulting in 1.5 million deaths annually. Tuberculosis involving the peripheral nerve is difficult to detect. Sural nerve tuberculoma is an extremely rare case of tuberculous involvement of the peripheral nerve that has attracted the attention of physicians. This paper reports a patient with sural nerve tuberculoma. A 58-year-old female patient presented with a palpable mass on the posterolateral calf with progressive tingling sensation on the distal area. The patient had no history of trauma and it was unclear whether the patient had any contact with individuals with active tuberculosis. The histopathologic findings revealed a granuloma-like lesion with caseous necrosis that was compatible with tuberculoma.

Exploring Neuropsychiatric Interphase in Perinatal Period – A Case Series

Perinatal period spans from conception till one-year post-partum. Pregnancy and post-partum ischaracterised by significant biological changes in a woman’s body including changes in blood pressure,blood volume, coagulability of blood and changes in immunity causing onset or relapse of certain medicaland neurological conditions, which can face diagnostic and treatment challenges during this period. We aimto present a series of 3 cases which presented with psychiatric symptoms but on further evaluation werefound to have neurological diagnosis – Cavernous Venous Thrombosis [CVT], Posterior ReversibleEncephalopathy Syndrome [PRES] & Tuberculoma.