Mohammadian Mahsa, Butt Saira
Shiraz University of Medical Sciences, Shiraz, Iran.
Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA.
IDCases. 2019 Jun 25;17:e00582. doi: 10.1016/j.idcr.2019.e00582. eCollection 2019.
Intracranial tuberculoma is one of the rare central nervous system manifestations of (MTB), seen in only 1% of tuberculosis patients. It can manifest as single or multiple lesions, most commonly located in the frontal and parietal lobes. Clinical features are similar to any space-occupying lesion in the brain and can present in the absence of MTB symptoms in other parts of the body. In this article, a 69-year-old immunocompetent man, with history of treated latent tuberculosis infection (LTBI) was reported. He presented with multiple joint arthralgias, weight loss, odd behavior, forgetfulness, intermittent fevers and syncope. Brain imaging revealed numerous enhancing intra-parenchymal lesions in cerebral and cerebellar hemispheres. Patient was successfully treated with anti-tuberculosis medications and corticosteroids, with clinical improvement on future follow ups. High clinical suspicion for tuberculoma as a differential diagnosis of any brain lesion, even in immunocompetent patients in low MTB prevalence countries, can result in early diagnosis and successful clinical outcomes.
颅内结核瘤是结核分枝杆菌（MTB）罕见的中枢神经系统表现之一，仅见于1%的结核病患者。它可表现为单个或多个病灶，最常见于额叶和顶叶。临床特征与脑内任何占位性病变相似，且可在身体其他部位无MTB症状的情况下出现。本文报道了一名69岁免疫功能正常的男性，有潜伏性结核感染（LTBI）治疗史。他出现多关节疼痛、体重减轻、行为怪异、健忘、间歇性发热和晕厥。脑部影像学检查显示大脑和小脑半球有多个脑实质内强化病灶。患者接受抗结核药物和皮质类固醇治疗成功，后续随访临床症状改善。即使在MTB患病率较低国家的免疫功能正常患者中，对结核瘤作为任何脑病变的鉴别诊断保持高度临床怀疑，也可实现早期诊断并取得成功的临床结果。
