Intracranial tuberculomas or neurocysticercosis: differentiated by cervical lymph node pathology.

Background: Diagnosis of tuberculomas can be difficult in the absence of pulmonary involvement due to numerable mimics. Case report: We report an immunocompetent 20-year-old female patient, who was admitted with new-onset generalized seizure. Cranial magnetic resonance imaging (MRI) revealed multiple ring-enhancing lesions. There was no reported systemic symptom such as weight loss, fever or night sweating. Polymerase chain reaction for SARS-COV-2 was negative. Computed tomography of thorax was normal. With an initial diagnosis of neurocysticercosis, she was treated with albendazole for one month. Follow-up cranial MRI showed no improvement. On follow-up visit, an enlarged cervical lymph node was recognized. Biopsy of the lymph node led to the diagnosis of tuberculosis. Two months after the onset of anti-tuberculosis therapy, follow-up cranial MRI showed near-complete resolution. Conclusion: Investigation of any involvement of disease other than the central nervous system can enable accurate and timely diagnosis of tuberculomas in the absence of pulmonary involvement.

Incidental discovery of a case of renal tuberculoma after intravesical BCG treatment.

Intravesical BCG treatment used in the management of NMIBC, usually presents as side effects: pollakiuria, hematuria, fever. Rarer complications may occur, affecting all organs of the urinary tract. Renal tuberculoma, a rare complication of intravesical BCG treatment, may be asymptomatic. It will be necessary to think about it, in front of the appearance of a tumoral lesion of renal localization post intravesical BCG treatment.

Global morbidity and mortality of central nervous system tuberculosis: a systematic review and meta-analysis.

BACKGROUND: Tuberculosis (TB) is the second most common cause of death due to a single infectious agent worldwide after COVID-19. Up to 15% of the cases are extrapulmonary, and if it is located in the central nervous system (CNS-TB), it presents high morbidity and mortality. Still, the global epidemiology of CNS-TB remains unknown. AIM: To estimate the global prevalence and incidence of CNS-TB based on the available literature. METHODS: We systematically searched in MEDLINE, Cochrane Central, Scopus, and LILACS databases (April 2020) and included observational studies evaluating the epidemiology of CNS-TB. Two independent researchers selected and assessed the quality of the studies and extracted relevant data. We performed random-effects model meta-analysis of proportions to estimate the pooled prevalence. The protocol of this study was registered in PROSPERO (CRD 42018103946). RESULTS: We included 53 studies from 28 countries, representing 12,621 patients with CNS-TB. The prevalence of CNS-TB was 2 per 100,000 inhabitants. According to the clinical setting, the prevalence of CNS-TB represented the 13.91% of all cases of meningitis and 4.55% of all cases of TB. The mortality was calculated by tuberculous meningitis due to the lack of data of other presentation, and it rose up to 42.12% in hospitalized patients. The burden of countries' TB, Human Development Index (HDI), and the prevalence of HIV were the most important prevalence moderators, especially in patients with TB. No data on incidence were found. CONCLUSION: The prevalence and mortality of CNS-TB remain high, and TB meningitis is the most frequent presentation. The highest prevalence was reported in developing countries, and its main moderators were the countries' HDI and HIV infection. Our study was limited by high heterogeneity, risk of bias, and potential data under registration from developing countries. The integration of CNS-TB early detection and management into national TB programs and population-based studies from developing countries are needed for better global estimation and response.

TUBERCULOSE MIMETIZANDO IMPLANTES SECUNDÁRIOS EM PULMÃO

Introdução: Na tuberculose pulmonar (TBp), os principais padrões radiológicos são cavitação e nódulos centrolobulares com padrão de árvore em brotamento, predominantemente nos lobos superiores, e espessamento das paredes brônquicas. No entanto, podemos encontrar manifestações radiológicas atípicas como os tuberculomas pulmonares, tornando o diagnóstico, nestes casos, mais desafiador. Geralmente, o tuberculoma pulmonar aparece isolado e ocorre em cerca de 5% dos casos de tuberculose pulmonar. Nódulos múltiplos, que mimetizam neoplasia pulmonar ou metástases, por sua vez, são ainda mais incomuns. Descrição do caso: Trata-se de uma paciente do sexo feminino, 43 anos, hipertensa, asmática e com diagnóstico de espondiloartrite com início do quadro, do qual não soube precisar data, caracterizado por tosse seca diária e eventualmente com secreção branca ou hemoptise, que piora à noite e melhora parcialmente com anti-histamínico. Há cerca de 1 ano e meio, apresentou dor em dorso e precórdio, que piorava ao esforço físico e tosse, sem fatores de melhora. Há 10 meses, apresentou dispneia aos pequenos esforços, quando teve diagnóstico de COVID-19, porém os sintomas pulmonares se exacerbaram progressivamente. Relata também sudorese noturna e perda ponderal de 7 kg em 3 meses. Em março de 2021, realizou PET CT que evidenciou nódulos pulmonares múltiplos em lobos inferiores e superior direito, sem atividade metabólica específica e de etiologia a esclarecer. Foi realizada segmentectomia pulmonar à direita, no entanto a análise histopatológica da peça revelou processo inflamatório crônico e extensas áreas de necrose caseosa em segmento de lobo inferior direito, sugerindo diagnóstico de TBp, sendo encaminhada para nosso serviço especializado. Foi descartado o HIV. Após 4 meses de uso de rifampicina, isoniazida, pirazinamida e etambutol, 4 comprimidos por dia, paciente refere melhora da tosse seca e da sudorese noturna, além de melhora da adinamia e astenia. Comentários: Geralmente, nódulos pulmonares múltiplos são malignos, chegando a responder a 80% dos casos. No entanto, tuberculose pulmonar no Brasil e na região nordeste, deve sempre ser considerada como diagnóstico diferencial, mesmo diante de imagem não típica.

Avoiding Anchoring Bias in the Times of the Pandemic!

COVID-19 has a broad spectrum of clinical presentations, including central nervous system manifestations that are not uncommon. The high pretest probability of COVID-19 in pandemic can lead to anchoring. We present a patient of COVID-19 pneumonia who presented with dyspnea and acute confusional state. His initial workup was suggestive of tuberculous meningoencephalitis with lymphocytic pleocytosis, high protein in CSF analysis, and suspicious MRI findings, which was later confirmed with a positive CSF culture. To the best of our knowledge, it is the first such case. Anchoring to the diagnosis of COVID-19 may deter clinicians from considering other concurrent diagnoses and a poor outcome consequently.