Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Dec 6:10:9-16.
doi: 10.1016/j.jctube.2017.12.004. eCollection 2018 Jan.

A patient with central nervous system tuberculomas and a history of disseminated multi-drug-resistant tuberculosis

Samantha R Kaplan  1 , Jeffrey Topal  1 , Lynn Sosa  2 , Maricar Malinis  1 , Anita Huttner  3 , Ajay Malhotra  4 , Gerald Friedland  1
Affiliations

A patient with central nervous system tuberculomas and a history of disseminated multi-drug-resistant tuberculosis

Samantha R Kaplan et al. J Clin Tuberc Other Mycobact Dis. .

Erratum in

  • Erratum regarding previously published articles.
    [No authors listed] [No authors listed] J Clin Tuberc Other Mycobact Dis. 2020 Sep 9;21:100177. doi: 10.1016/j.jctube.2020.100177. eCollection 2020 Dec. J Clin Tuberc Other Mycobact Dis. 2020. PMID: 32964144 Free PMC article.

Abstract

Tuberculosis (TB) is one of the leading causes of death worldwide, particularly in low- and middle-income countries. The global rates and numbers of drug resistant TB are rising. With increasing globalization, the spread of drug-resistant strains of TB has become a mounting global public health concern. We present a case of a young man previously treated for multi-drug resistant (MDR) TB in India who presented with neurological symptoms and central nervous system TB in the United States. His case highlights unique diagnostic and treatment challenges that are likely to become more commonplace with the increase of patients infected with drug-resistant TB and complicated extrapulmonary disease.

Keywords: AFB, acid-fast bacilli; BAL, bronchoalveolar lavage; Bedaquiline; CNS, central nervous system; CSF, cerebrospinal fluid; CT, computerized tomography; Central nervous system (CNS) TB; DOT, directly observed therapy; DST, drug susceptibility testing; Extensively drug-resistant tuberculosis (XDR-TB); FDA, Food and Drug Administration; IV, intravenous; LUL, left upper lobe; MDR-TB, multidrug-resistant tuberculosis; MRI, magnetic resonance imaging; Multi-drug resistant tuberculosis (MDR-TB); TB, tuberculosis; Tuberculoma; Tuberculosis (TB); WHO, World Health Organization; XDR-TB, extensively drug-resistant tuberculosis.

PubMed Disclaimer

Figures

Fig 1
Fig. 1
Case narrative timeline.
Fig 2
Fig. 2
Serial MRIs of medulla lesion. (A) June 2014: pre-treatment. T2 sagittal. Arrow points to location of lesion in the medulla (B) June 2014: pre-treatment. T2 sagittal, enlarged (C) June 2014: pre-treatment, T2 axial (D) October 2014: two months into treatment, T2 axial (E) March 2015: seven months into treatment, T2 axial (F) July 2016: at completion of treatment course, T2 axial. This image shows similar size lesion compared with pre-treatment, but marked diminution of edema around lesion. (All images are Spin Echo T2 WI without contrast).
Fig 3
Fig. 3
Pathology from frontal lobe lesion (A and B). The hematoxylin & eosin stained biopsy samples show several granulomas, including one granuloma with necrotic center ('caseating necrosis’, arrow in B). Numerous inflammatory cells are present throughout the biopsy, (C) demonstrates CD68 positive macrophages and (D) shows CD3 positive T-lymphocytes.
See this image and copyright information in PMC

References

    1. World Health Organization Tuberculosis fact sheet 2016 19 October Available from: 2016. http://www.who.int/mediacentre/factsheets/fs104/en/
    1. World Health Organization . World Health Organization; 2016. WHO treatment guidelines for drug-resistant tuberculosis: 2016 update.
    1. Bernaerts A, Vanhoenacker FM, Parizel PM, Van Goethem JW, Van Altena R, Laridon A. Tuberculosis of the central nervous system: overview of neuroradiological findings. Eur Radiol. 2003;13(8):1876–1890. - PubMed
    1. Donmez FY, Coskun M, Guven G. Medulla oblongata tuberculoma mimicking metastasis presenting with stroke-like symptoms. Neurol Sci. 2009;30:349–352. - PubMed
    1. Bayindir C, Mete O, Bilgic B. Retrospective study of 23 pathologically proven cases of central nervous system tuberculomas. Clin Neurol Neurosurg. 2006;108(4):353–357. - PubMed

LinkOut - more resources