Disseminated tuberculosis in a pregnant woman presenting with numerous brain tuberculomas: case report

Abstract

-Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, which has the pulmonary form as the most common presentation. Dissemination of the disease is common in immunocompromised patients, but immunodeficiency related to pregnancy severe enough to cause dissemination of the Mycobacteria is exceedingly rare. When dissemination occurs, any organ may be affected and in central nervous system, the infection presents as meningitis and single brain parenchyma tuberculomas. We report the case of a 17 year-old woman at the 34th week of pregnancy with respiratory and high intracranial pressure symptoms. On the day before admission she had a sudden onset of paraparesis and urinary retention and ten hours after the delivery she presented with paraplegia . The chest X-ray and CT scan were compatible with miliary tuberculosis. The cranial CT scan revealed numerous rounded hypodense lesions located at cerebral and cerebellar hemispheres, which presented ring-like enhancement after contrast injection. The patient underwent a craniotomy with biopsy of the lesions confirming the diagnosis of brain tuberculomas. The three-drug regimen was started and the cranial CT scan performed a year after diagnosis showed no brain lesions. We emphasize the aggressive dissemination of the disease in this case associated with pregnancy and the importance of early diagnosis and institution of therapy resulting in regression of the lesions.KEY WORDS: central nervous system, tuberculosis, pregnancy, tuberculoma. T T T T Tuberculose disseminada em uma paciente grávida apresentando múltiplos tuberculomas cerebrais: uberculose disseminada em uma paciente grávida apresentando múltiplos tuberculomas cerebrais: uberculose disseminada em uma paciente grávida apresentando múltiplos tuberculomas cerebrais: uberculose disseminada em uma paciente grávida apresentando múltiplos tuberculomas cerebrais: uberculose disseminada em uma paciente grávida apresentando múltiplos tuberculomas cerebrais: relato de caso. relato de caso. relato de caso. relato de caso. relato de caso.RESUMO -A tuberculose é doença infecciosa causada pelo Mycobacterium tuberculosis e tem na forma pulmonar a sua apresentação mais comum. A disseminação da doença é comum em pacientes imunodeprimidos. Entretanto, imunodeficiência relacionada à gravidez suficientemente severa para causar disseminação da micobactéria é rara. Quando a disseminação ocorre, qualquer órgão pode ser afetado e, quando ela se faz para o sistema nervoso central, apresenta-se mais comumente como meningite ou tuberculoma único. Relatamos o caso de uma paciente de 17 anos na 34 ª semana de gestação com sintomas pulmonares e hipertensão intracraniana. No dia anterior ao internamento a paciente apresentou episódio súbito de paraparesia e retenção urinária. A paciente evoluiu para parto normal e dez horas após apresentou paraplegia. A radiografia simples e a tomografia de tórax foram compatíveis com tuderculose miliar. A tomografia de crânio mostrou múltiplas lesões hipodensas arredondadas nos hem...

Multiple cerebral tuberculomas without focal neurological deficit in an immunocompetent adult Nigerian: A case report

“…The complete resolution of lesions on medical therapy alone which has been documented previously (14,20,21), is supported by our report.…”

“…Treatment of intracranial tuberculoma may be surgical when the lesions are large and few, and are causing focal neurological deficits, as in the cases reported by Muin and Zurin (7), or medical when the lesions are small and numerous like in our case and that of Innocenti et al (5) and Gasparetto et al (14). The complete resolution of lesions on medical therapy alone which has been documented previously (14,20,21), is supported by our report.…”

“…The lack of focal neurological signs in our patient is in contrast to reported cases (5)(6)(7)(8)14). CT brain scan is useful in the diagnosis of cerebral tuberculoma (7,13,15,16).…”

“…Cerebral tuberculoma is an important differential diagnosis in patients with focal neurological signs in areas endemic for TB (7,8), not only in immune-compromised patients (14,15), but also in immune-competent patients with miliary pulmonary TB, when TB meningitis has been excluded.…”

“…Multiple cerebral tuberculomas are more often associated with miliary TB in children (17) although some reports in adults also show this association (5,14).…”