Kapadia Shashi, Patrawalla Amee
Rutgers New Jersey Medical School, Newark, NJ, United States.
IDCases. 2014 Nov 4;1(4):97-100. doi: 10.1016/j.idcr.2014.10.010. eCollection 2014.
Tuberculoma involving the cavernous sinus is a rare presentation of CNS disease, with only twelve cases reported in previous literature. We report a case of a 48 year old woman who presented with a right cavernous sinus syndrome of 2 months duration. MRI showed a mass in the right cavernous sinus, and serologic workup revealed an elevated sedimentation rate and positive Quantiferon(®)-GOLD testing. 18-FDG PET-CT demonstrated a hypermetabolic 3 cm subcarinal lymph node, and lymph node biopsy showed caseating granuloma. Culture of lymphatic tissue grew drug-sensitive M. tuberculosis. The patient was treated with a non-standard 4-drug regimen and prednisone, with rapid improvement of symptoms and radiologic abnormalities. Total length of treatment was 12 months. In addition, we review the 12 cases found in literature, and discuss clinical features, diagnostic dilemmas, and approaches to treatment.
累及海绵窦的结核瘤是中枢神经系统疾病的一种罕见表现，既往文献仅报道过12例。我们报告一例48岁女性，出现持续2个月的右侧海绵窦综合征。磁共振成像（MRI）显示右侧海绵窦有一个肿块，血清学检查显示血沉升高，结核菌素皮肤试验（Quantiferon(®)-GOLD）呈阳性。18氟脱氧葡萄糖正电子发射断层显像（18-FDG PET-CT）显示隆突下有一个3厘米的高代谢淋巴结，淋巴结活检显示干酪样肉芽肿。淋巴组织培养培养出对药物敏感的结核分枝杆菌。该患者接受了非标准的四联药物治疗方案及泼尼松治疗，症状和影像学异常迅速改善。治疗总时长为12个月。此外，我们回顾了文献中发现的12例病例，并讨论了临床特征、诊断困境及治疗方法。
