A Rare Presentation of Invasive Tuberculosis of the Central Nervous System in an Immunocompetent Patient in a Nonendemic Country

Abstract

We herein report a rare case of a 25-year-old immunocompetent male patient with disseminated tuberculosis of central nervous system (CNS), first presenting as multiple cerebral lesions with no meningeal involvement. Subsequent diagnostic workup disclosed extensive peritoneal involvement. A broad differential diagnosis was considered, including neoplastic and infectious diseases. The diagnosis was confirmed with positive PCR result for Mycobacterium tuberculosis in the biopsied mesenteric tissue. The patient was started on tuberculostatic regimen with favorable outcome. No acquired or hereditary immunodeficiency was documented. Disseminated tuberculosis in immunocompetent individuals is extremely rare. Genetic susceptibility factors have been reported in individuals with extensive forms of the disease and a high index of suspicion is required, as observed in our case.

Magic Dr.T? Tuberculous brain lesions in an immunocompetent patient-A case report

“…Genetic susceptibility factors such as defects in the interleukin-12 (IL-12) and interferon-gamma pathways are reported in patients presenting with extensive forms of the disease [ 7 ].…”

“…Surgery is usually not indicated as the tuberculomas usually resolve with anti-tuberculous drugs and conservative treatment, but in case of a diagnostic dilemma or in cases of increased intracranial pressure despite treatment is when surgery is indicated [ 7 ]. This is well illustrated in our patient as the tuberculomas had completely resolved following 6 months treatment and surgery was only indicated because of the posed diagnostic dilemma thus necessitating a need for excisional biopsy.…”

A Case Report of Widely Disseminated Tuberculosis in Immunocompetent Adult Male

“…Despite previous reports of CNS dissemination of TB, this case stands to acknowledge the difficulty of diagnosis in the ED, and the need for emergency physicians (EP) to maintain a broad differential including disseminated TB as a possibility from the beginning of assessment. [8][9][10][11][12] In this case EPs should be aware of predisposing factors of disseminated TB in patients presenting with nonspecific symptoms. These predisposing factors include impaired cell-mediated immunity as seen in HIV/acquired immune deficiency syndrome patients, increased use of immunosuppressive drugs, diminished ability of the liver to clear bacteria from the bloodstream as seen in advanced liver disease among others, and recent immigration from areas with high rates of TB.…”