Pediatric sellar-suprasellar tubercular abscess:A case report and literature review

Abstract@#Sellar-suprasellar tuberculoma represents 1% of all intracranial tuberculomas, which can convert into a pituitary abscess. @*Objectives@#This paper aims to present a case of a common lesion in an uncommon site,discuss the challenges in diagnosis in terms of clinical manifestations, imaging and histologic findings, discuss aholistic approach to treatment,and enumerate identified clinical outcomes of reported cases in literature. @*Methodology@#This paper presents a case report of a sellar-suprasellar tubercular abscess,and reviews similar cases reported in literature. @*Results@#This is acase of a 16-year old female, Filipino, presenting with a chronic history of intermittent headache, fever, blurring of peripheral vision, polyuria, and increased sleeping time. On neurologic examination, the patient had bitemporal hemianopsia and decreased visual acuity on the right eye. Neuroimaging revealed a hypodense lesion at the sellar-suprasellar area with rim-enhancement on CT and MRI, and laboratory findings suggestive of panhypopituitarism. She underwent Right Pterional Craniotomy and intraoperatively there was note of a firm, yellowish capsule with intracapsular yellowish viscous fluid, which was positive for acid fast bacilli. Marsupialization of abscess was performed and hormonal replacement and anti-tubercular medications were given. @*Conclusion@#Tuberculoma in the sellar-suprasellar area, can impinge on the optic chiasm, producing bitemporal hemianopsia and pituitary dysfunction.It presents like other sellar-suprasellar masses with non-specific symptoms and these masses share similar features on cranial CT scan. Due to the complexity of the disease, treatment of sellar-suprasellar TB requires integrated management of an infectious disease expert, neurologist, neurosurgeon, endocrinologist, and adolescent medicine specialist. Outcomes of four other cases found in literature were generally good after aspiration or drainage of the abscess followed by TB treatment for 15 to 18 months with resulting improvement invision, marked reduction in the size or complete resolution of the mass, but with one case having loss of pituitary function.

A case of subretinal tubercular abscess presenting as disc edema.

We report a case of ocular tuberculosis (TB) which initially presented with disc edema and was mistaken for optic neuritis. With no definite pathology being identified, the patient was treated on the lines of optic neuritis with intravenous (IV) steroid with beneficial effect. Ocular TB was suspected when he presented later with a subretinal abscess. Based on positive Mantoux, QuantiFERON TB gold results and radiographic findings, a diagnosis of subretinal abscess of presumed tubercular etiology was made. The patient was successfully treated with anti‑tubercular therapy. To the best of our knowledge, this is the first case report of ocular TB presenting as disc edema followed by subretinal abscess.

Anterior Chest Wall Tuberculosis Involving Lungs, Pleura and Lymph Nodes in an Immunocompetent Patient: A Case Report.

Aims: The chest wall tuberculosis accounts for 1-5% of all cases of musculoskeletal tuberculosis. Here we are presenting a rare case of anterior chest wall tuberculosis in an immunocompetent patient. Presentation of Case: A 20-year-old male came for routine medical check-up, which was prerequisite for his job. He had no respiratory complaints with no history of fever and weight loss. Local examination revealed a swelling over the right chest in the infraclavicular region. Discussion: Tubercular anterior chest wall abscess is a rare form of extra pulmonary TB. Simultaneous involvement of lung, pleura and lymph nodes of mediastinum, neck and axilla has rarely been reported in an immunocompetent individual. Conclusion: Cold abscess of chest wall is not common. Anti-tubercular therapy should be recommended as initial treatment.

Isolated homonymous hemianopsia due to presumptive cerebral tubercular abscess as the initial manifestation of human immunodeficiency virus infection.

We report a case of isolated homonymous hemianopsia due to presumptive cerebral tubercular abscess as the initial manifestation of human immunodeficiency virus (HIV) infection. A 30-year-old man presented to our outpatient department with sudden loss of visibility in his left visual field. He had no other systemic symptoms. Perimetry showed left-sided incongruous homonymous hemianopsia denser above the horizontal meridian. Magnetic resonance imaging revealed irregular well-marginated lobulated lesions right temporo-occipital cerebral hemisphere and left high fronto-parietal cerebral hemisphere suggestive of brain tubercular abscess. Serological tests for HIV were reactive, and the patient was started only on anti-tubercular drugs with the presumptive diagnosis of cerebral tubercular abscess. Therapeutic response confirmed the diagnosis. Atypical ophthalmic manifestations may be the initial presenting feature in patients with HIV infection. This highlights the need for increased index of suspicion for HIV infection in young patients with atypical ophthalmic manifestations.

A rare case of tubercular cerebellar abscess.

Tubercular brain abscess are uncommon and tubercular cerebellar abscess are rarely reported. Most of these cases occur in immunocompromised patients. We report a case of multiple cerebellar abscesses in a 55-year-old HIV seronegative non-diabetic female, who complained of headache, neck pain and unsteadiness of gait since two months. She had been on treatment for pulmonary tuberculosis, diagnosed earlier. Diagnosis was made by CT scan of brain and confirmed by bacteriological examination of drained pus obtained by suboccipital craniotomy. The patient showed signs of recovery.

Spinal Intramedullary Tubercular abscess.

Spinal intramedullary tubercular abscess is an extremely rare entity. Only few cases are reported in literature. A Nine-year-old girl presented with pain in gluteal region and progressive paraparesis. Her chest-X-ray revealed a primary focus suggesting pulmonary Koch’s & MRI lumbosacral spine showed a ring enhancing hypointese lesion in T1w and hyperintense in T2w at L2 to L3 suggestive of epidermoid or tubercular abscess, which was confirmed at operation and subsequently by AFB staining and culture. Mycobacterium tuberculosis was seen in both staining and culture of pus. Patient improved after 2 months of ATT.