Department of Chest Medicine, Castlehill Hospital, Cottingham, UK.
Department of Infectious Diseases, Castlehill Hospital, Cottingham, UK.
J Med Microbiol. 2011 Oct;60(Pt 10):1550-1552. doi: 10.1099/jmm.0.022251-0. Epub 2011 Jun 9.
We report a case of a previously healthy 23-year-old Somalian care assistant. She presented with a 4 month history of persistent occipital headaches associated with intermittent nausea and vomiting. Computed tomography and magnetic resonance imaging of the brain showed a large enhancing lesion in the right cerebellar hemisphere with surrounding ring lesions, suggestive of an intracranial neoplasm with metastases. However, tuberculoma of the brain was confirmed based on histology of the excision biopsy and cerebrospinal fluid (CSF) culture results: Mycobacterium tuberculosis resistant to isoniazid (INH) with sensitivity to other standard drugs, including fluoroquinolones, was cultured from CSF. No primary focus to suggest spread from elsewhere was found. The patient was treated successfully with moxifloxacin, rifampicin, pyrazinamide and ethambutol. Isolated INH-resistant intracranial tuberculoma is rare in adults. It can mimic other intracranial masses and should be kept in mind, especially in populations with a high risk of tuberculosis. Clinical use of moxifloxacin in INH-resistant tuberculomas is limited in humans and this case demonstrates that moxifloxacin may be an effective alternative treatment.
我们报告了一例先前健康的 23 岁索马里护理助理。她因持续性枕部头痛伴间歇性恶心和呕吐而就诊，病史已有 4 个月。头颅计算机断层扫描和磁共振成像显示右小脑半球有一个大的增强病变，伴有周围环状病变，提示颅内肿瘤伴转移。然而，基于切除活检和脑脊液（CSF）培养结果的组织学检查，确诊为脑结核瘤：从 CSF 中培养出对异烟肼（INH）耐药但对包括氟喹诺酮类在内的其他标准药物敏感的结核分枝杆菌。未发现提示来自其他部位传播的原发性病灶。该患者成功接受莫西沙星、利福平、吡嗪酰胺和乙胺丁醇治疗。成人中孤立性 INH 耐药性颅内结核瘤罕见。它可能模仿其他颅内肿块，尤其是在结核病高风险人群中，应予以考虑。莫西沙星在 INH 耐药性结核瘤中的临床应用在人类中受到限制，本病例表明莫西沙星可能是一种有效的替代治疗方法。
