Giese A, Kucinski T, Hagel C, Lohmann F
Department of Neurosurgery, University Hospital Luebeck, Luebeck, Germany.
Acta Neurochir (Wien). 2003 Jun;145(6):513-7; discussion 517. doi: 10.1007/s00701-003-0019-0.
We present the unusual occurrence of multiple systemic and two central nervous system tuberculomas in an immunocompetent young patient. A large left frontal epidural tuberculoma with transcalvarian extension was removed surgically and chemotherapy was initiated. The patient remained on a chemotherapy with INH, RMP, and EMB and was followed clinically and with MRI scans for 24 months. Findings. The clinical presentation and neuroimaging studies initially suggested malignant disease. Surgical resection of the left frontal lesion was required to relieve the mass effect. The histological evaluation showed a granulomatous inflammation with epithelial and Langhans giant cells, but no acid-fast bacilli. Cultures of the specimens yielded a mixed infection with Corynebacterium species and Staphylococcus epidermidis. Based on the histological findings, chemotherapy for tuberculosis was initiated. Subsequently, Mycobacterium tuberculosis was cultured from the surgical specimen and sputum. Interpretation. Parenchymal CNS tuberculosis with or without extracerebral manifestations may present as a space-occupying lesion. Because a tuberculoma is rarely suspected especially if there is atypical morphology, biopsy is required to establish the diagnosis and expedite specific treatment.
我们报告了一例免疫功能正常的年轻患者出现多个系统性和两个中枢神经系统结核瘤的罕见情况。手术切除了一个经颅骨扩展的巨大左侧额叶硬膜外结核瘤，并开始化疗。患者继续接受异烟肼、利福平、乙胺丁醇化疗，并进行了24个月的临床随访和磁共振成像扫描。结果：临床表现和神经影像学研究最初提示为恶性疾病。需要手术切除左侧额叶病变以减轻占位效应。组织学评估显示为肉芽肿性炎症，伴有上皮样细胞和朗汉斯巨细胞，但未发现抗酸杆菌。标本培养发现棒状杆菌属和表皮葡萄球菌混合感染。根据组织学结果，开始抗结核化疗。随后，手术标本和痰液中培养出结核分枝杆菌。解读：有或无脑外表现的实质性中枢神经系统结核可能表现为占位性病变。由于结核瘤很少被怀疑，特别是如果形态不典型，需要活检以确诊并加快特异性治疗。
