Yuzawa Hiroko, Hirose Yousuke, Kimura Tomonori, Kimura Sho, Sugawara Hisanori, Yanagisawa Asako, Toi Sono, Ohashi Takashi, Sadahiro Tomohito
Department of Emergency and Critical Care Medicine Tokyo Women's Medical University Yachiyo Medical Center Yachiyo Chiba Japan.
Department of Neurology Tokyo Women's Medical University Yachiyo Medical Center Yachiyo Chiba Japan.
Acute Med Surg. 2017 Apr 4;4(3):329-333. doi: 10.1002/ams2.272. eCollection 2017 Jul.
A 42-year-old Peruvian woman residing in Japan for 11 years with a family history of neurocysticercosis presented to our intensive care unit with fever and intense headache.Computed tomography indicated multiple micronodular lesions in the brain parenchyma, and cerebral tuberculoma and neurocysticercosis were considered in the differential diagnosis. Neurocysticercosis was initially suspected, and oral praziquantel was initiated. However, because of a high adenosine deaminase level in the cerebrospinal fluid and positive peripheral blood interferon gamma release test result, cerebral tuberculoma was subsequently considered.
Antituberculous drugs with steroids were initiated on day 10, after which the symptoms gradually resolved; the patient was discharged on day 29. Gadolinium-contrast magnetic resonance imaging 8 months later showed reduced nodular shadows, confirming cerebral tuberculoma.
Immediate diagnosis and treatment are imperative for cerebral tuberculoma, a lethal infection. Considering the recent increases in immigration worldwide, increased cases of tuberculoma mimicking neurocysticercosis are expected.
一名42岁的秘鲁女性，在日本居住11年，有神经囊尾蚴病家族史，因发热和剧烈头痛入住我们的重症监护病房。计算机断层扫描显示脑实质内有多个微小结节性病变，鉴别诊断考虑为脑结核瘤和神经囊尾蚴病。最初怀疑是神经囊尾蚴病，开始口服吡喹酮。然而，由于脑脊液中腺苷脱氨酶水平较高且外周血干扰素γ释放试验结果呈阳性，随后考虑为脑结核瘤。
第10天开始使用抗结核药物联合类固醇，此后症状逐渐缓解；患者于第29天出院。8个月后钆增强磁共振成像显示结节阴影减少，确诊为脑结核瘤。
脑结核瘤是一种致命感染，必须立即进行诊断和治疗。考虑到最近全球移民人数的增加，预计模仿神经囊尾蚴病的结核瘤病例会增多。
