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. 2013 Jun 3:9:34-7.
doi: 10.1016/j.rmcr.2013.04.003. eCollection 2013.

Cerebral tuberculomas - A clinical challenge

Regina Monteiro  1 , José Carlos Carneiro  1 , Claúdia Costa  2 , Raquel Duarte  3
Affiliations

Cerebral tuberculomas - A clinical challenge

Regina Monteiro et al. Respir Med Case Rep. .

Abstract

Cerebral tuberculomas are a rare and serious form of tuberculosis (TB) due to the haematogenous spread of Mycobacterium Tuberculosis (MT). Symptoms and radiologic features are nonspecific, leading sometimes to misdiagnosis. Anti-TB drugs are essential for the successful treatment of cerebral tuberculomas but there is no agreement regarding the duration of therapy. The authors present a case of a 55 years old male, presented to the emergency room with sudden onset of diplopia. Cerebral computerized tomography revealed multiple brain lesions, with contrast enhancement and peri-lesional oedema. The patient was HIV negative and because of previous malignancy the first suspicion was metastatic disease. Cultural exam of the bronchial wash showed MT sensitive to all first-line drugs. The patient started antituberculosis treatment with 4 drugs (HRZE) for 2 months, followed by maintenance therapy (HR). Treatment was prolonged for 24 months because at 12th and 18th months of treatment one of the brain lesions, although significantly smaller, still showed contrast enhancement. Even though it is not clear if contrast enhancement lesions represent active lesions or just inflammation, continuing treatment until total resolution of the tuberculomas is probably prudent.

Keywords: Cerebral tuberculomas; Disseminated tuberculosis.

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Figures

Fig. 1
Fig. 1
Brain MR before treatment: 4 space occupying lesions in the brain with central necrosis, irregular outlines with peripheral contrast enhancing and moderate peri-lesional oedema.
Fig. 2
Fig. 2
Thoracic CT before treatment: peri-centimetric mediastinal lymph nodes; bilateral lung micronodules and a small condensation area in the right middle lobe with discrete air bronchogram; lytic lesion at the left 8th rib-vertebral joint.
Fig. 3
Fig. 3
PET scan: abnormal enhancement in multiple small foci in both lung fields; lymph nodes and bone lesions (3rd and 8th left ribs and right iliac wing).
Fig. 4
Fig. 4
First and last brain MR (after 24 months of treatment): total resolution of the tuberculomas.
See this image and copyright information in PMC

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