Asunto(s)
Antituberculosos , Humanos , Antituberculosos/uso terapéutico , Mycobacterium tuberculosis/aislamiento & purificación , Mycobacterium tuberculosis/efectos de los fármacos , Tuberculosis/tratamiento farmacológico , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Miliar/diagnóstico por imagenRESUMEN
La tuberculosis es una enfermedad muy frecuente en nuestro medio. A pesar de que la detección precoz y el tratamiento adecuado logran la curación en la mayoría de los pacientes, la dificultad en el diagnóstico, el abandono del tratamiento y la aparición de resistencia a los fármacos tradicionales generan que, en la actualidad, continúe siendo un importante problema de salud pública. En la Argentina, la tasa de morbilidad es de 25/100 000 habitantes, con un leve aumento en la mortalidad.Se presenta el caso de una paciente pediátrica con tuberculosis, que tuvo múltiples complicaciones asociadas a la enfermedad y a su tratamiento, entre las cuales se incluye el síndrome in-flamatorio de reconstitución inmunológica, también conocido como reacción paradojal al tratamiento antituberculoso. Este representa una consecuencia clínica adversa al restablecimien-to de la inmunidad en el paciente que padece una infección sistémica grave, como la tuberculosis miliar.
Tuberculosis is a very frequent disease in our environment. Although early detection and adequate treatment achieve cure in most patients, the difficulty in diagnosis, the abandonment of treatment and the appearance of resistance to traditional drugs generate that at present it continues to represent an im-portant public health problem. In Argentina, the morbidity rate is 25/100,000 inhabitants, with a slight increase in mortality.We present the case of a pediatric patient with tuberculosis and multiple complications associated with the disease and its treatment. One of these complications was the immune re-constitution inflammatory syndrome or paradoxical reaction to antituberculosis treatment. It represents an adverse clinical con-sequence of the restoration of immunity in the patient suffering from a serious systemic infection such as miliary tuberculosis.
Asunto(s)
Humanos , Femenino , Niño , Tuberculosis/complicaciones , Tuberculosis Miliar/diagnóstico , Síndrome Inflamatorio de Reconstitución Inmune , Tuberculosis Meníngea , Tuberculosis Miliar/tratamiento farmacológicoRESUMEN
Tuberculosis is a very frequent disease in our environment. Although early detection and adequate treatment achieve cure in most patients, the difficulty in diagnosis, the abandonment of treatment and the appearance of resistance to traditional drugs generate that at present it continues to represent an important public health problem. In Argentina, the morbidity rate is 25/100,000 inhabitants, with a slight increase in mortality. We present the case of a pediatric patient with tuberculosis and multiple complications associated with the disease and its treatment. One of these complications was the immune reconstitution inflammatory syndrome or paradoxical reaction to antituberculosis treatment. It represents an adverse clinical consequence of the restoration of immunity in the patient suffering from a serious systemic infection such as miliary tuberculosis.
La tuberculosis es una enfermedad muy frecuente en nuestro medio. A pesar de que la detección precoz y el tratamiento adecuado logran la curación en la mayoría de los pacientes, la dificultad en el diagnóstico, el abandono del tratamiento y la aparición de resistencia a los fármacos tradicionales generan que, en la actualidad, continúe siendo un importante problema de salud pública. En la Argentina, la tasa de morbilidad es de 25/100 000 habitantes, con un leve aumento en la mortalidad. Se presenta el caso de una paciente pediátrica con tuberculosis, que tuvo múltiples complicaciones asociadas a la enfermedad y a su tratamiento, entre las cuales se incluye el síndrome inflamatorio de reconstitución inmunológica, también conocido como reacción paradojal al tratamiento antituberculoso. Este representa una consecuencia clínica adversa al restablecimiento de la inmunidad en el paciente que padece una infección sistémica grave, como la tuberculosis miliar.
Asunto(s)
Antituberculosos/efectos adversos , Síndrome Inflamatorio de Reconstitución Inmune/inducido químicamente , Tuberculosis Miliar/tratamiento farmacológico , Antituberculosos/uso terapéutico , Niño , Femenino , HumanosRESUMEN
We describe the case of a 61-year-old man from the Dominican Republic admitted with diarrhoea, fevers and weight loss who was found to have lab studies and imaging (including radiolabeled somatostatin positron emission tomography/CT scan) initially consistent with a metastatic neuroendocrine tumour. However, after weeks of workup and multiple inconclusive biopsies, he was diagnosed with disseminated extrapulmonary tuberculosis. Here we examine the data for neuroendocrine tumour and tuberculosis labs and imaging to delineate where these studies overlap. We also analyse the biases and pitfalls in this case that led to a protracted diagnosis.
Asunto(s)
Tumores Neuroendocrinos/diagnóstico , Tuberculosis Miliar/diagnóstico , Antituberculosos/uso terapéutico , Diagnóstico Diferencial , República Dominicana , Humanos , Masculino , Persona de Mediana Edad , Tumores Neuroendocrinos/diagnóstico por imagen , Tuberculosis Miliar/diagnóstico por imagen , Tuberculosis Miliar/tratamiento farmacológicoRESUMEN
Central nervous system (CNS) tuberculosis includes three clinical entities: tuberculous meningitis, intracranial tuberculoma, and spinal tuberculous arachnoiditis. All three categories are encountered frequently in regions of the world where the incidence of TB is high. Meningeal tuberculosis is a medical emergency: it is the most severe, lethal and disabling form of tuberculosis. Early diagnosis and treatment can be lifesaving. Even, in developed countries the diagnosis of tuberculous meningitis is difficult, frequently delayed or missed, and is often not microbiologically confirmed. Here I report a case of miliary tuberculosis, in a patient with diabetes mellitus and chronic kidney disease, but without HIV infection. Although the patient had regular contact with healthcare staff (hemodialysis), miliary tuberculosis diagnosis was considerably delayed. This patient, subsequently evolved into tuberculous meningitis. In spite of quadruple anti-tuberculosis treatment, corticosteroids, and general supportive care, this case resulted in death.
Asunto(s)
Tuberculoma Intracraneal/complicaciones , Tuberculosis Meníngea/complicaciones , Tuberculosis Miliar/complicaciones , Tuberculosis Pulmonar/complicaciones , Antituberculosos/uso terapéutico , Diagnóstico Tardío , Nefropatías Diabéticas/complicaciones , Errores Diagnósticos , Resultado Fatal , Femenino , Humanos , Hipertensión/complicaciones , Persona de Mediana Edad , Diálisis Renal , Insuficiencia Renal Crónica/complicaciones , Tuberculoma Intracraneal/diagnóstico por imagen , Tuberculoma Intracraneal/tratamiento farmacológico , Tuberculosis Meníngea/diagnóstico por imagen , Tuberculosis Meníngea/tratamiento farmacológico , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/diagnóstico por imagen , Tuberculosis Pulmonar/tratamiento farmacológicoAsunto(s)
Humanos , Lactante , Preescolar , Niño , Bronconeumonía/tratamiento farmacológico , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pleural/tratamiento farmacológico , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Meníngea/tratamiento farmacológico , Tuberculosis Osteoarticular/tratamiento farmacológico , Fibrosis Quística/tratamiento farmacológico , PediatríaAsunto(s)
Hemorragia Gastrointestinal/etiología , Enfermedades del Yeyuno/etiología , Tuberculosis Miliar/complicaciones , Dolor Abdominal/etiología , Adulto , Antituberculosos/uso terapéutico , Bolivia/etnología , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Enfermedades del Yeyuno/diagnóstico , Enfermedades del Yeyuno/diagnóstico por imagen , Laparoscopía , Masculino , Desnutrición/complicaciones , Neoplasias Peritoneales/diagnóstico , Peritonitis Tuberculosa/diagnóstico , Peritonitis Tuberculosa/tratamiento farmacológico , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/tratamiento farmacológicoAsunto(s)
Enfermedades de la Coroides/diagnóstico , Tuberculosis del Sistema Nervioso Central/diagnóstico , Tuberculosis Miliar/diagnóstico , Tuberculosis Ocular/diagnóstico , Tuberculosis Pulmonar/diagnóstico , Antituberculosos/uso terapéutico , Niño , Enfermedades de la Coroides/tratamiento farmacológico , Enfermedades de la Coroides/microbiología , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Masculino , Tuberculosis del Sistema Nervioso Central/tratamiento farmacológico , Tuberculosis del Sistema Nervioso Central/microbiología , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Miliar/microbiología , Tuberculosis Ocular/tratamiento farmacológico , Tuberculosis Ocular/microbiología , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/microbiologíaRESUMEN
The hyper Immunoglobulin E syndrome, also known as Job's syndrome, is a rare primary immunodeficiency, its mechanisms of inheritance maybe recessive or dominant autosomal. It is characterized by high levels of IgE, eosinophilia, skin abscesses, eczema, chronic mucocutaneous candidiasis and recurrent pulmonary infections all of which contribute to the development of pneumatoceles and bronchiectasis. The most frequently isolated bacteria is Staphylococcus aureus. Currently, despite the highest survival of patients, lymphomas and other opportunistic infections have been reported. There are few reports of patients with Mycobacterium tuberculosis infection associated with hyper IgE syndrome. Therefore it is relevant that we report a case history of a patient with pulmonary tuberculosis, presenting miliary tuberculosis and severe respiratory compromise, who responded positively to standard anti-tuberculous treatment with first line drugs.
Asunto(s)
Inmunoglobulina E/sangre , Síndrome de Job/complicaciones , Tuberculosis Miliar/complicaciones , Humanos , Isotipos de Inmunoglobulinas/sangre , Masculino , Factor de Transcripción STAT3/genética , Tuberculosis Miliar/tratamiento farmacológico , Adulto JovenRESUMEN
El síndrome de hiper IgE también denominado síndrome de Job, es una inmunodeficiencia primaria poco frecuente, cuyo modo de herencia puede ser autosómico recesivo o dominante. Se caracteriza por altos niveles de IgE, eosinofilia, abscesos cutáneos, eccema, candidiasis mucocutánea crónica e infecciones pulmonares recidivantes que contribuyen al desarrollo de neumatoceles y bronquiectasias. El germen más frecuentemente aislado es el Staphylococcus aureus. En la actualidad, ante la mayor supervivencia de los pacientes se han comunicado infecciones oportunistas y linfomas. Existen escasas publicaciones de pacientes con enfermedad por Mycobacterium tuberculosis asociada a síndrome de hiper IgE, por lo que consideramos relevante comunicar el caso de un paciente con antecedentes de una tuberculosis pulmonar, que presentó una tuberculosis miliar con grave compromiso respiratorio, con buena respuesta al tratamiento estándar con drogas de primera línea.
The hyper Immunoglobulin E syndrome, also known as Job´s syndrome, is a rare primary immunodeficiency, its mechanisms of inheritance maybe recessive or dominant autosomal. It is characterized by high levels of IgE, eosinophilia, skin abscesses, eczema, chronic mucocutaneous candidiasis and recurrent pulmonary infections all of which contribute to the development of pneumatoceles and bronchiectasis. The most frequently isolated bacteria is Staphylococcus aureus. Currently, despite the highest survival of patients, lymphomas and other opportunistic infections have been reported. There are few reports of patients with Mycobacterium tuberculosis infection associated with hyper IgE syndrome. Therefore it is relevant that we report a case history of a patient with pulmonary tuberculosis, presenting miliary tuberculosis and severe respiratory compromise, who responded positively to standard anti-tuberculous treatment with first line drugs.
Asunto(s)
Humanos , Masculino , Adulto Joven , Inmunoglobulina E/sangre , Síndrome de Job/complicaciones , Tuberculosis Miliar/complicaciones , Isotipos de Inmunoglobulinas/sangre , /genética , Tuberculosis Miliar/tratamiento farmacológicoRESUMEN
La tuberculosis en Chile ha tenido un considerable descenso en incidencia y mortalidad, encontrándonos en la etapa de eliminación como problema de salud pública. Sin embargo, a medida que la tuberculosis pulmonar disminuye en frecuencia, la proporción de tuberculosis extrapulmonar se incrementa. Como es conocido, el pulmón es el órgano diana por excelencia, pero cualquier órgano puede ser afectado. Dentro de las tuberculosis extrapulmonares, la forma miliar corresponde sólo a un 5 por ciento de los casos. La diseminación miliar es rara en pacientes inmunocompetentes, estando prácticamente restringida a grupos de riesgo. El diagnóstico de la tuberculosis miliar requiere de un alto índice de sospecha, ya que su clínica es inespecífica, y el aislamiento del bacilo de Koch difícil.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/tratamiento farmacológico , Antibióticos Antituberculosos/uso terapéutico , InmunocompetenciaRESUMEN
BACKGROUND: Frequency of adrenal insufficiency in patients with tuberculosis varies from 0 to 58%; however, all published series excluded severely ill patients. Our objective was to investigate adrenal insufficiency with the low-dose cosyntropin test in patients with severe active tuberculosis. METHOD: From two large university affiliated hospitals, 18 patients with tuberculosis and criteria of sepsis or severe sepsis according to SCCM/ACCP criteria, defined by the present authors as severe active tuberculosis, participated in the study. A low-dose ACTH test with 10 mg of ACTH was performed. After ACTH test, all patients received a stress dose of hydrocortisone (240 mg/day) during their entire hospitalization along with four antituberculous drugs. Abnormal response was considered when elevation of serum cortisol was <7 microg/dl with respect to basal level, 60 min after ACTH administration. RESULTS: Adrenal insufficiency was found in seven patients (39%); no clinical or laboratory data were associated with the presence of abnormal adrenal response. Except in one patient with HIV infection, all the signs and symptoms improved after antituberculous and hydrocortisone treatment. The increment in serum cortisol value post-ACTH test was lower in patients with hypoalbuminemia. CONCLUSIONS: Adrenal insufficiency is frequent in severe active tuberculosis. The efficacy and security of supplemental steroid treatment in severe active tuberculosis should be established by a randomized clinical trial.
Asunto(s)
Insuficiencia Suprarrenal/diagnóstico , Cosintropina , Hidrocortisona/sangre , Tuberculosis Pulmonar/complicaciones , Insuficiencia Suprarrenal/tratamiento farmacológico , Insuficiencia Suprarrenal/etiología , Adulto , Antituberculosos/uso terapéutico , Cosintropina/administración & dosificación , Quimioterapia Combinada , Etambutol/administración & dosificación , Femenino , Infecciones por VIH/complicaciones , Humanos , Hidrocortisona/metabolismo , Hidrocortisona/uso terapéutico , Isoniazida/uso terapéutico , Masculino , Persona de Mediana Edad , Pirazinamida/administración & dosificación , Rifampin/uso terapéutico , Sepsis/tratamiento farmacológico , Sepsis/etiología , Sepsis/fisiopatología , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Miliar/fisiopatología , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/fisiopatologíaRESUMEN
BACKGROUND: Frequency of adrenal insufficiency in patients with tuberculosis varies from 0 to 58%; however, all published series excluded severely ill patients. Our objective was to investigate adrenal insufficiency with the low-dose cosyntropin test in patients with severe active tuberculosis. METHOD: From two large university affiliated hospitals, 18 patients with tuberculosis and criteria of sepsis or severe sepsis according to SCCM/ACCP criteria, defined by the present authors as severe active tuberculosis, participated in the study. A low-dose ACTH test with 10 mg of ACTH was performed. After ACTH test, all patients received a stress dose of hydrocortisone (240 mg/day) during their entire hospitalization along with four antituberculous drugs. Abnormal response was considered when elevation of serum cortisol was <7 microg/dl with respect to basal level, 60 min after ACTH administration. RESULTS: Adrenal insufficiency was found in seven patients (39%); no clinical or laboratory data were associated with the presence of abnormal adrenal response. Except in one patient with HIV infection, all the signs and symptoms improved after antituberculous and hydrocortisone treatment. The increment in serum cortisol value post-ACTH test was lower in patients with hypoalbuminemia. CONCLUSIONS: Adrenal insufficiency is frequent in severe active tuberculosis. The efficacy and security of supplemental steroid treatment in severe active tuberculosis should be established by a randomized clinical trial.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Cosintropina , Hidrocortisona/sangre , Insuficiencia Suprarrenal/diagnóstico , Tuberculosis Pulmonar/complicaciones , Antituberculosos/uso terapéutico , Cosintropina/administración & dosificación , Quimioterapia Combinada , Etambutol/administración & dosificación , Hidrocortisona , Hidrocortisona/uso terapéutico , Infecciones por VIH/complicaciones , Insuficiencia Suprarrenal/tratamiento farmacológico , Insuficiencia Suprarrenal/etiología , Isoniazida/uso terapéutico , Pirazinamida/administración & dosificación , Rifampin/uso terapéutico , Sepsis/tratamiento farmacológico , Sepsis/etiología , Sepsis/fisiopatología , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Miliar/fisiopatología , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/fisiopatologíaRESUMEN
Liver involvement in tuberculosis in absence of miliary tuberculosis is rare. This study was performed to analyse the spectrum and response to treatment of hepatic tuberculosis in the absence of miliary abdominal tuberculosis. Retrospective analysis of seven cases of hepatic tuberculosis without miliary abdominal tuberculosis who presented at the single tertiary referral center were analyzed. All patients presented with fever and hepatomegaly. Five of them had pain in upper abdomen and vomiting. HIV serology was positive in one patient. All patients had normocytic normochromic anaemia, raised erythrocyte sedimentation rate (Mean 65). Mild elevation of liver enzymes and low albumin (Mean 2.4 gm%) with reversal of albumin globulin ratio (Mean 0.6) were seen in all. Two had jaundice. Prothrombin time was normal in all and lactate dehydrogenase values were elevated in all (Mean 794 IU/L). On ultrasonography, 2 had multiple hypodense lesion, 1 had coarse echotexture of liver, 1 had hyperechoic pattern and 3 had just hepatomegaly. Complete resolution of liver lesions on treatment with 4-drug anti-tuberculosis drug chemotherapy was seen. In conclusion, liver tuberculosis has protean manifestations with nonspecific alteration of liver function tests and is best diagnosed on liver biopsy. Overall response to therapy is satisfactory.
Asunto(s)
Tuberculosis Hepática/diagnóstico , Tuberculosis Hepática/epidemiología , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/epidemiología , Adolescente , Adulto , Anciano , Antituberculosos/uso terapéutico , Biopsia con Aguja , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Muestreo , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Prueba de Tuberculina , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Miliar/tratamiento farmacológico , Ultrasonografía DopplerRESUMEN
We describe the case of a 36-years-old male patient, originating from India, who presented with enlarged cervical lymph nodes and elevated liver chemistry tests. Histologically necrosing granulomas were observed in the lymph nodes, and PCR revealed DNA from mycobacterium tuberculosis. However, in the liver biopsy granulomatous hepatitis without central necrosis was seen. With a positive PCR for mycobacteria from liver tissue and no evidence for other hepatic diseases we started drug treatment with standard quadruple regimen consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide. Five days after onset of therapy, liver chemistry tests rose 10-fold, forcing us to interrupt treatment. Gradual step-wise re-exposition with the same medication after return of liver chemistry tests to baseline was well tolerated without any further side effects. Liver involvement of tuberculosis can have many facets and may be treated by gradual dosing of standard drugs.
Asunto(s)
Antituberculosos/administración & dosificación , Isoniazida/administración & dosificación , Hígado/efectos de los fármacos , Tuberculosis Hepática/tratamiento farmacológico , Tuberculosis Miliar/tratamiento farmacológico , Adulto , Antituberculosos/efectos adversos , Biopsia , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Quimioterapia Combinada , Etambutol/administración & dosificación , Etambutol/efectos adversos , Humanos , Isoniazida/efectos adversos , Hígado/microbiología , Hígado/patología , Ganglios Linfáticos/patología , Masculino , Pirazinamida/administración & dosificación , Pirazinamida/efectos adversos , Rifampin/administración & dosificación , Rifampin/efectos adversos , Tuberculosis Hepática/patología , Tuberculosis Miliar/patologíaRESUMEN
A progresive decrease of tuberculosis incidence has been shown in the last years in Chile. Presently Chile is considered as a country with a low incidence of tuberculosis (< 20 cases per 10(5) inhabitants). Miliary tuberculosis is an uncommon form of tuberculosis in immunocompetent patients. Miliary tuberculosis is tipically observed in immunocompromised patients. It is an infrequent cause of nosocomial fever. We report a case of miliary tuberculosis in an immunocompetent patient, that caused intrahospitalary fever, in the course of a long term hospitalization.
La tuberculosis ha disminuido su incidencia en los últimos años en Chile, siendo considerado actualmente como un país con baja incidencia de tuberculosis (< 20 casos por 10(5) habitantes). Dentro de las diferentes formas de presentación clínica de la tuberculosis, la diseminación miliar es rara en pacientes inmunocompetentes, estando restringida prácticamente a determinados grupos de riesgo. Más excepcional aún es considerar a la tuberculosis miliar como causa de fiebre intrahospitalaria. Comunicamos un caso de tuberculosis miliar en un paciente inmunocompetente, como causa de fiebre nosocomial, durante una hospitalización prolongada.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Tuberculosis Miliar/complicaciones , Fiebre de Origen Desconocido/etiología , Tuberculosis Miliar/diagnóstico , Tuberculosis Miliar/tratamiento farmacológico , Hospitalización , InmunocompetenciaRESUMEN
CONTEXT: Tuberculosis is an important public health issue. The Brazilian government reported 78,460 new cases in 1999. Miliary tuberculosis is a severe form of this disease. OBJECTIVE: To report on an uncommon clinical presentation of miliary tuberculosis in a child. CASE REPORT: A 5-year old boy presented in the emergency room with fatigue and weight loss. He had had Staphylococcus aureus pneumonia 7 months before. Chest radiography revealed lobar consolidation and miliary pattern associated with small cavities in both upper lobes. Antibiotic therapy was started. The sputum was positive for acid-fast bacilli and hence the treatment recommended for tuberculosis (rifampicin, isoniazid [INH], pyrazinamide) was started. The patient was treated for 9 months and at the end of the follow-up period he had made a complete clinical recovery. CONCLUSION: Although in some particular cases sputum can be positive for acid-fast bacilli in children, limitations to the sputum test have forced pediatricians to base tuberculosis diagnosis on epidemiological data, clinical findings and radiographic pattern. In this particular case, we hypothesize that the sputum bacillus test was positive because bacilli grew inside residual pneumatoceles that were produced during previous pneumonia.
Asunto(s)
Mycobacterium tuberculosis/aislamiento & purificación , Esputo/microbiología , Tuberculosis Miliar/diagnóstico , Tuberculosis Pulmonar/diagnóstico , Técnicas Bacteriológicas/métodos , Preescolar , Humanos , Masculino , Mycobacterium tuberculosis/metabolismo , Radiografía , Tuberculosis Miliar/diagnóstico por imagen , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Pulmonar/diagnóstico por imagen , Tuberculosis Pulmonar/tratamiento farmacológicoRESUMEN
The classical presentation of neurotuberculosis is meningitis. Intracranial tuberculomas are a rare manifestation of neurotuberculosis and are due to hematogenous dissemination of distant focuses of Mycobacterium tuberculosis infection. Around 1% of patients with central nervous system tuberculosis develop intracranial tuberculomas some weeks or months after the beginning of the specific treatment with tuberculostatic chemotherapy. The involution of the lesions is slow and does not mean drug resistance nor lack of adequate treatment. We describe the case, diagnosed and treated at the 25th Infirmary of Santa Casa da Misericórdia do Rio de Janeiro, of an immunocompetent male patient who developed meningitis and multiple intracranial tuberculomas during the specific treatment of miliary tuberculosis. The literature is revised and the diagnosis, treatment and possible immunological mechanisms are discussed.
Asunto(s)
Tuberculoma Intracraneal/etiología , Tuberculosis Pulmonar/tratamiento farmacológico , Adulto , Antituberculosos/uso terapéutico , Humanos , Isoniazida/uso terapéutico , Imagen por Resonancia Magnética/métodos , Masculino , Pirazinamida/uso terapéutico , Rifampin/uso terapéutico , Tomografía Computarizada por Rayos X/métodos , Tuberculoma Intracraneal/diagnóstico , Tuberculoma Intracraneal/tratamiento farmacológico , Tuberculosis Meníngea/diagnóstico , Tuberculosis Meníngea/tratamiento farmacológico , Tuberculosis Meníngea/etiología , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/tratamiento farmacológico , Tuberculosis Pulmonar/complicacionesRESUMEN
A forma clássica de apresentação da neurotuberculose é a meningite. Os tuberculomas cerebrais são formas raras de neurotuberculose e resultam da disseminação hematogênica de focos distantes de infecção pelo Mycobacterium tuberculosis. Aproximadamente 1 por cento dos pacientes com tuberculose do sistema nervoso central desenvolve tuberculomas intracranianos, poucas semanas ou meses após o início da quimioterapia tuberculostática. A involução das lesões é lenta e não necessariamente significa resistência medicamentosa ou falta de aderência ao tratamento. Descrevemos o caso, diagnosticado e tratado na 25ª Enfermaria da Santa Casa da Misericórdia do Rio de Janeiro, de um paciente imunocompetente que apresentou meningite e tuberculomas múltiplos do sistema nervoso central, durante o tratamento específico de tuberculose miliar. A literatura é revisada e o diagnóstico, terapêutica e possíveis mecanismos imunológicos são discutidos.