A 66-year-old female who had undergone an orthotopic liver transplant two years before admission was admitted with fever and neurological symptoms of several days' duration. Following an extensive work-up, which revealed positive intracranial lesions on computed typography and magnetic resonance imaging, the patient was begun on broad spectrum antimicrobials including corticosteroids. The patient responded though the etiology of infection remained unclear. After a stereotactic biopsy was performed revealing granulomas and acid-fast bacilli, the patient was started on antituberculous medications. A review of the literature reveals that the rare occurrence of intracranial tuberculoma should be considered in an orthotopic liver transplant (OLT) patient with central nervous system pathology.
Case ReportThe incidence and factors associated with tuberculosis in liver transplant patients are not clear (1,2). Tuberculosis involving the central nervous system occurs in only 0.53% of cases of systemic tuberculosis in this country (3). Though intracranial tuberculoma is a common entity in developing countries, cases of tuberculosis involving the central nervous system (either tuberculomas or meningitis) have rarely been reported (4,5). Intracranial tuberculoma in the liver transplant patient has not been previously described. We report a case of a patient who developed neurological symptoms, likely related to intracranial tuberculoma, and died from cerebral hemorrhage.
88An indigenous 66-year-old hispanic female with a history of noninsulin dependent diabetes mellitus, who had a cadaveric liver transplantation for cirrhosis two years earlier, was admitted for confusion, headache, fever, vomiting and diarrhea. The patient was recently discharged after being hospitalized for fever, headache, and confusion without a diagnosis. There was no previous history of tuberculosis in the patient or her family; her purified protein derivative (PPD) status before admission and transplantation was unknown.The patient was in good health several days earlier and was taking prednisone 10 mg qd, cyclosporine 25 mg bid, nystatin, cardiazem and neurontin. The patient denied recent travel, any contact with illness and had no pets.On examination, the patient was febrile, 40.1 aeC, pulse 110 beats/min, blood pressure 133/71 mmHg, respiratory rate 20 breaths/min, and was saturating 98% on room air. She was alert, yet disoriented. No meningismus or adenopathy was noted. Examination of the heart, lungs, and the abdomen was normal. Cranial nerves were intact, and muscle strength was within normal limits, including deep tendon reflexes.Laboratory analysis revealed: hemoglobin, 11.0 g/dL; hematocrit, 31.6%; platelets, 345 ¿ 10 9 /L; white blood cells (WBC), 11.8 ¿ 10 9 /L, with 83.7% neutrophils; sodium, 136 mmol/L; potassium, 3.8 mmol/L; chloride, 101 mmol/L; carbon dioxide, 19; BUN, 60 mmol/L; creatinine, 2.5 mg/dL; glucose, 128 mg/dL; total bilirubin 0.7 mg/dL, direct bilirubin 0.3 mg/ dL, AST Ω 41 U/L, ALT Ω 15 U/L, AP Ω 194 U/L; a PPD was not per...
