Giant tuberculoma in an adolescent: atypical form of tuberculosis

Abstract

SummaryA tuberculoma is a rare form of presentation of tuberculosis (TB) in children. We describe the case of a 13-year-old girl, with 3 weeks of progressive tiredness and asthenia and a 48 h fever and cough. Physical examination revealed diminished pulmonary sounds in the left lower hemithorax. A chest radiograph showed an oval hypotransparency image in this location. The TB skin test was anergic and sputum was negative for acid-fast bacilli (AFB). The thoracic CT revealed a cystic mass in the left lower half hemithorax, compressing the adjacent pulmonary lobe, with double non-calcificated membrane. The exeresis of the pulmonary mass was performed and the anatomopathological study revealed a tuberculoma with AFB. TB treatment was established with a favourable clinical and radiological evolution. TB is a prevalent disease around the world. In this case, due to the mass dimensions and adjacent-organ compression, surgery was essential for a favourable clinical evolution. BACKGROUND

Pulmonary tuberculoma: does persistent imaging lesion equals treatment failure?

“…Even with bronchoscopy, lavage samples are often not collected from the lesion. 1,4 Concerning the imaging diagnosis, chest radiography can also fail to detect these lesions, requiring a chest-CT. 1,4 Diagnosis confirmation frequently requires invasive procedures such as percutaneous needle aspiration or thoracotomy. 1 In these cases, anti-bacillar treatment was sufficient for significant size reduction, but surgery may be necessary in some cases.…”

“…1,4 Concerning the imaging diagnosis, chest radiography can also fail to detect these lesions, requiring a chest-CT. 1,4 Diagnosis confirmation frequently requires invasive procedures such as percutaneous needle aspiration or thoracotomy. 1 In these cases, anti-bacillar treatment was sufficient for significant size reduction, but surgery may be necessary in some cases. 1 Treatment duration is not well stablished and is often a dilemma, given that tuberculomas may persist after treatment and continue to decrease for several months before complete resolution.…”

“…Pulmonary tuberculoma comprises the development of well-circumscribed masses in the lung and represent a rare form of pulmonary tuberculosis in children. 1,2 It can be a manifestation of primary as well as postprimary disease. 3 Tuberculomas can remain stable for a long time; however, in cases of immunosuppression, the lesions may spread and disseminate or liquefy and form cavitary lesions.…”

“…Treatment course is still controverse and up for discussion since tuberculomas may persist after treatment raising doubts of treatment efficacy. [1][2][3]…”

Pneumonia or tuberculosis? A case report in a teenage girl

“…Tuberculosis might manifest in an unusual way and imitate other lung disease entities. Mascarenhas et al [6] reported an unusual case of a giant tuberculoma in an adolescent. A 13-year-old girl had in her chest a large cystic lesion that was initially treated as a hydatid cyst.…”