Gavazzi G, Bouchard O, Bosseray A, Leclerq P, Micoud M
Service de Médecine interne et Maladies infectieuses, CHU A. Michallon, Grenoble.
Presse Med. 1998 Jun 6;27(20):958-62.
Extrapulmonary localizations are observed in 20% of tuberculosis cases, mainly in immunosuppressed patients. Prognosis is poor in case of relatively uncommon cerebral localizations and miliary dissemination, especially if treatment is initiated in late stages. We report a case of disseminated tuberculosis associated with cerebral and pulmonary localizations in an immunocompetent patient. THe disease progressed despite adapted treatment.
A young immunocompetent man with an uneventful history developed miliary tuberculosis with pulmonary localizations visualized on the computed tomography (CT) of the thorax. Brain CT was normal, but magnetic resonance imaging revealed several intracranial lesions. The disease course was marked by development of neurological symptoms and progression of the cerebral lesions after one month of treatment. No evidence of therapeutic failure (insufficient dosing, non-compliance, primary resistance) could be identified.
Magnetic resonance imaging provides a more precise evaluation of tuberculosis lesions in the brain. Early antituberculosis therapy associated with corticosteroids can improve prognosis. Clinicians should be aware that cerebral lesions may continue to progress despite appropriate treatment, a course which is not satisfactorily explained by any current pathogenic hypothesis.
肺外结核定位在20%的结核病病例中可见，主要见于免疫抑制患者。相对少见的脑结核定位和粟粒性播散预后较差，尤其是在疾病晚期才开始治疗时。我们报告一例免疫功能正常患者发生的伴有脑和肺定位的播散性结核病病例。尽管采取了适当治疗，病情仍进展。
一名既往史无异常的年轻免疫功能正常男性发生粟粒性肺结核，胸部计算机断层扫描（CT）显示有肺部定位。脑部CT正常，但磁共振成像显示有几处颅内病变。病程以治疗1个月后出现神经症状和脑病变进展为特征。未发现治疗失败（剂量不足、不依从、原发耐药）的证据。
磁共振成像能更精确地评估脑部结核病变。早期抗结核治疗联合皮质类固醇可改善预后。临床医生应意识到，尽管进行了适当治疗，脑病变仍可能继续进展，目前的任何致病假说都无法令人满意地解释这一病程。
