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A Case of Miliary Tuberculosis With Symptomatic Huge Intracranial Tuberculomas FREE TO VIEW

Tarek Djenfi, PhD; Redha Selmani, PhD; Abdelmadjid DJEBBAR, PhD
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University Hadj Lakhdar Batna, Batna, Algeria

Chest. 2015;148(4_MeetingAbstracts):152A. doi:10.1378/chest.2274842
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SESSION TITLE: Infections Global Case Reports

SESSION TYPE: Global Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Combined clinical forms of pulmonary and extrapulmonary tuberculosis are relatively rare in non-immunocompromised patients.

CASE PRESENTATION: We describe a case of 31-year-old man with a generalised febrile miliary treated as due to tuberculosis (tuberculin skin test (TST) negative, smear negative, HIV negative, Hepatitis B and C serologic testing negative) A good clinical evolution with normalization of liver function was noticed after few days of TB treatment with isoniazid, rifampicin, pyrazinamide and ethambutol. One month later, the patient presented with a sudden onset of dysphagia to solids, vomiting and swallowing trouble followed by neurological deficits such paraesthesia of left upper and lower limbs and dysarthria. The patient received gastrointestinal transits that revealed pulmonary aspiration in trachea and left bronchi. MRI of brain showed multiple and huge intracranial tuberculomas. Their size is up to 20.7 mm. The patient was readmitted to the respiratory unit for a gastric feeding tube, a preventive seizures treatment was started with high-dose corticosteroid therapy. The outcome was favourable under medical treatment in few days with improvement in dysphagia and neurological disorders. MRI performed nine months later objectified complete disappearance of brain damage.

DISCUSSION: Combination of brain tuberculoma and miliary tuberculosis is common in immunocompromised patients but only few cases were reported in immunocompetent patients. The haematogenous spread of bacilli attending, mainly the lungs but other localizations can be observed particularly in nervous system Brain tuberculomas mainly occurr in the cerebrum and cerebellum. In this patient, after an initial response to treatment, neurological deficits (dysphagia, vomiting, swallowing trouble and dysarthria) were developed despite anti-TB treatment. This observation was reported by other authors, it is due to the expansion of brain tuberculomas the first few weeks up to the 20 mm. Prolonged high-dose steroid therapy and preventive seizures treatment with the same antituberculosis therapeutic regimen was efficient.

CONCLUSIONS: Existence of any neurological sign in patient with miliary tuberculosis of lung should alert to brain MRI

Reference #1: Multiple Tuberculoma Involving the Brain and Spinal Cord in a Patient with Miliary Pulmonary Tuberculosis Hyun-Seok Park, M.D. and Young-Jin Song, M.D.corresponding author J Korean Neurosurg Soc. 2008 Jul; 44(1): 36-39.

Reference #2: Miliary tuberculosis with left brachial monoplegia: A case report Nayyar Iqbal,corresponding author Nagarajan Natarajan, Sivakumar Periyasamy, Sanjoy George, Aneesh Basheer, and Sudhagar Mookkappan

Reference #3: Milliary tuberculosis with unusual paradoxical response at 3 weeks of antituberculous treatment. Chaudhry LA1, Ebtesam Ba-Essa, Al-Solaiman S. Australas Med J. 2014; 7(10): 400-404. J Coll Physicians Surg Pak. 2012 Jan;22(1):43-5. doi: 01.2012/JCPSP.4345

DISCLOSURE: The following authors have nothing to disclose: Tarek Djenfi, Redha Selmani, Abdelmadjid DJEBBAR

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