Disseminated tuberculosis

Case contributed by Dr Krister Askaner

Presentation

Patient from sub Saharan Africa. Cough, night sweats, and weight loss.

Patient Data

Age: 25 years
Gender: Female
CT

Small nodules bilaterally with a random distribution. Right paratracheal calcified enlarged lymph node (4R).

MRI

Brain:
Multiple ring enhancing lesions in cerebellum and brainstem. Multiple dot-like contrast-enhancing lesions in cerebrum. Some areas with leptomeningeal contrast enhancement. No signs of restricted diffusion on DWI.

Spine:
Two similar lesions are seen intramedullary at the level of C3 and T12.
No evidence of vertebral body involvement.

Findings consistent with multiple intracranial and intramedullary tuberculomas

Case Discussion

Miliary pulmonary TB in combination with multiple tuberculomas in the brain and spine is a very rare condition. The prevalence of intramedullary tuberculoma has been reported in 1-2/100,000 patients with tuberculosis 1.

Presence of Mycobacterium tuberculosis was confirmed by PCR from broncho-alveolar lavage (BAL).

Tuberculomas are not to be confused with tuberculous abscesses which are far more uncommon. Abscesses are more associated with restricted diffusion in the core and more prominent perifocal edema. The multiplicity and small size of the lesions as in this case favor a diagnosis of tuberculomas.

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Case information

rID: 55671
Published: 4th May 2018
Last edited: 7th May 2018
Inclusion in quiz mode: Included
Institution: Skåne University Hospital

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