RESUMEN
Tuberculosis (Tb) is, currently, the deadliest infectious disease and is caused by organisms of the Mycobacterium tuberculosis complex; the most common clinical manifestation is pulmonary involvement; however, it can also manifest as extrapulmonary affection in immunocompromised patients, especially in patients with human immunodeficiency virus (HIV) chronic infection up to 20% of the cases, despite being on adequate antiretroviral therapy. Within the extrapulmonary manifestations, affection of the central nervous system by hematogenous dissemination occurs in up to 5%, however, the finding of tuberculomas, which is a form of central nervous system involvement, is rare and an important cause in secondary hydrocephalus in these patients. We present the case of a male patient with a history of HIV infection and meningeal tuberculosis, who presented dysfunction of his ventriculoperitoneal shunt and in the imaging study multiple tuberculomas were found, a cerebrospinal fluid study was performed where multi-resistant tuberculosis (MDR) was documented, therefore despite adequate management of Tb, tuberculomas developed. (AU)
La tuberculosis (Tb) es, actualmente, la enfermedad infecciosa más mortífera y está causada por organismos del complejo Mycobacterium tuberculosis; la manifestación clínica más común es la afectación pulmonar; sin embargo, también puede manifestarse como afección extrapulmonar en pacientes inmunocomprometidos, especialmente en pacientes con infección crónica por el virus de la inmunodeficiencia humana (VIH) hasta en un 20% de los casos, a pesar de estar en tratamiento antirretroviral adecuado. Dentro de las manifestaciones extrapulmonares, la afectación del sistema nervioso central por diseminación hematógena se presenta hasta en un 5%, sin embargo, el hallazgo de tuberculomas, que es una forma de afectación del sistema nervioso central, es raro y una causa importante en la hidrocefalia secundaria en estos pacientes. . Presentamos el caso de un paciente masculino con antecedentes de infección por VIH y tuberculosis meníngea, quien presentó disfunción de su derivación ventriculoperitoneal y en el estudio de imagen se encontraron múltiples tuberculomas, se le realizó estudio de líquido cefalorraquídeo donde se encontró tuberculosis multirresistente (MDR). documentados, por lo que a pesar del manejo adecuado de la Tb, se desarrollaron tuberculomas. (AU)
Asunto(s)
Humanos , Masculino , Adulto , Tuberculosis/diagnóstico por imagen , Tuberculosis/terapia , VIH , Tuberculosis Resistente a Múltiples Medicamentos , Espectroscopía de Resonancia MagnéticaRESUMEN
Tuberculosis remains one of the most common infectious diseases. Miliary presentation is a rare and possibly lethal form, resulting from massive lymphohaematogenous dissemination of Mycobacterium tuberculosis bacilli. The authors describe the case of a 47-year-old immunocompetent woman, diagnosed with miliary tuberculosis, with both lung and central nervous system involvement, who showed total recovery after starting anti-tuberculous drugs. The atypical neutrophilic-predominant pleocytosis and negative cerebrospinal fluid microbiological results made the diagnosis even more challenging. Since prognosis largely depends on timely treatment, recognition and prompt diagnosis is important. Thus, clinicians should be aware and treatment should be initiated as soon as the diagnosis is suspected. LEARNING POINTS: Cerebrospinal fluid (CSF) characteristics in central nervous system tuberculosis (CNS TB) are variable and may even be normal. Typical CSF findings include lymphocytic-predominant pleocytosis, although neutrophilic predominance may occur. CSF microbiological testing for Mycobacterium tuberculosis has low sensitivity, so a negative test does not eliminate the diagnosis.Cerebral magnetic resonance imaging is usually the test of choice, given its superiority in CNS TB diagnosis over computed tomography (CT), which can be normal.Chest x-ray may appear normal and miss miliary TB, which however a CT scan can identify.