RESUMO
Ocular metastases from systemic tumors are uncommon. The choroid is the most frequent target, with a preference for elderly individuals. Lung cancer is the predominant primary tumor that metastasizes to the eyes in males, although other ocular conditions such as uveitis and retinal lesions can mimic secondary tumor implants in ocular tissues. On fundoscopy, choroidal metastasis resembles other infectious processes, especially choroidal tuberculoma. Therefore, patients presenting with choroidal masses should undergo detailed clinical examinations, especially if the mass is the first manifestation of a systemic and severe disease. In this report, we describe a young man with a metastatic choroidal tumor secondary to papillary renal cell carcinoma mimicking a unilateral choroidal tuberculoma.
Assuntos
Carcinoma de Células Renais , Neoplasias da Coroide , Neoplasias Renais , Tuberculoma , Masculino , Humanos , Idoso , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/patologia , Corioide/patologia , Neoplasias da Coroide/diagnóstico , Neoplasias da Coroide/patologia , Neoplasias Renais/diagnóstico , Neoplasias Renais/patologia , Tuberculoma/diagnóstico , Tuberculoma/patologiaRESUMO
To present a young immunocompetent patient with a fourth ventricle tuberculoma without pulmonary tuberculosis. A previously healthy young male patient presented with a history of headache, nausea, and blurred vision. Neuroimaging revealed a mass present in the fourth ventricle. The lesion was successfully resected. Histological and microbiological findings suggested the presence of a tuberculoma. Tuberculomas can be found in the posterior fossa in adults. This infectious pathology should not be forsaken when considering the differential diagnosis for infratentorial masses.
Assuntos
Quarto Ventrículo/microbiologia , Tuberculoma/diagnóstico , Tuberculose do Sistema Nervoso Central/diagnóstico , Adulto , Antibióticos Antituberculose/uso terapêutico , Diagnóstico Diferencial , Quarto Ventrículo/patologia , Cefaleia/diagnóstico , Cefaleia/tratamento farmacológico , Cefaleia/etiologia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Neuroimagem , Tuberculoma/complicações , Tuberculoma/tratamento farmacológico , Tuberculoma/patologia , Tuberculose do Sistema Nervoso Central/tratamento farmacológicoAssuntos
Antituberculosos/uso terapêutico , Sistema Nervoso Central/fisiopatologia , Tuberculoma/diagnóstico , Tuberculoma/tratamento farmacológico , Tuberculose/complicações , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Colômbia , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Resultado do Tratamento , Tuberculoma/fisiopatologia , Tuberculose/fisiopatologiaRESUMO
ABSTRACT Choroidal tuberculomas are present in patients with ocular tuberculosis. They usually occur in a patient with previous history of tuberculosis, and are rarely the initial presentation, with no prior systemic manifestations. We present a patient with unilateral choroidal tuberculoma as the initial presentation of presumed ocular tuberculosis, which enabled earlier initiation of treatment.
RESUMO Os tuberculomas de coroide apresentam-se em pacientes com tuberculose ocular. Geralmente, ocorrem em indivíduos com história prévia de tuberculose e raramente têm apresentação inicial sem manifestações sistêmicas anteriores. Relatamos o caso de um paciente com tuberculoma de coroide unilateral com apresentação inicial de tuberculose ocular presumida, permitindo o início mais precoce do tratamento.
Assuntos
Humanos , Feminino , Adulto , Tuberculoma/diagnóstico , Doenças da Coroide/diagnóstico , Tuberculoma/tratamento farmacológico , Angiofluoresceinografia , Doenças da Coroide/tratamento farmacológico , Uveíte Posterior/diagnóstico , Tuberculose Ocular , Corioide/diagnóstico por imagem , Fundo de Olho , Antituberculosos/uso terapêuticoRESUMO
Tuberculosis (TB) of the central nervous system (CNS) is considered one of the most severe forms of presentation of the disease. Although only 1% of TB cases involve the CNS, these cases represent around between 5 and 15% of extrapulmonary forms.1,2 Tuberculous meningitis (TBM) is the most frequent form of CNS TB. The granulomas formed in the cerebral tuberculoma may cause hydrocephalus and other symptoms indicative of a CNS mass lesion. In the absence of active TB or TBM, the symptoms may be interpreted as indicative of tumors.3,4 The prognosis is directly related to the early diagnosis and proper treatment installation.5 We report the case of a patient with intracranial hypertension syndrome, expansive mass in the parieto-occipital region, accompanied by a lesion in the rib, initially thought to be a metastatic lesion, although posteriorly diagnosed as a cerebral tuberculoma.
Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Tuberculoma/diagnóstico , Tuberculoma/terapia , Tuberculoma Intracraniano/patologia , Tuberculose do Sistema Nervoso Central , Microcirurgia/métodos , Antituberculosos/uso terapêuticoRESUMO
La preocupación por los trastornos intestinales y la oclusión, como consecuencia de la formación de bridas peritoneoviscerales producidas por gestos quirúrgicos manuales e instrumentales, ha dado lugar a procedimientos con miras a evitarlas o minimizarlas. En este marco, la técnica de mesenteroplicatura con sostén transitorio tiene el propósito de favorecer el ordenamiento fibrointestinal, cuando la patología tratada haga sospechar que se producirán adherencias y más aún si la intervención ha sido causada por estas. Los fundamentos del procedimiento son los mismos que sostienen las técnicas usuales, por lo tanto no hay controversias en cuanto a las indicaciones. La lógica de la sutura transitoria está en que el tutor pierde su objetivo y se retira cuando finaliza el proceso adherencial, alrededor de las dos semanas de la intervención. Se presentan tres casos de oclusión intestinal operados con el procedimiento, controlados y con buenos resultados.
Peritoneal adhesions produced as a consequence of manual or instrumental manipulation during surgery cause bowel obstruction. Several procedures have been developed to avoid or minimize adhesions. Mesenteric plication with temporary suture support organizes the healing process in the bowel in case of high suspicion of adhesions will develop, particularly when bowel obstruction is produced by adhesions. The basis of this technique is the same as for standard procedures and, thus, there are no controversies about its indications. The rationale of temporary suture support is that when the healing process is over, about two weeks after the intervention, the suture support is no longer needed. We report three cases of intestinal obstruction undergoing mesenteric plication and temporary suture support, with favorable outcomes.
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Procedimentos Cirúrgicos Operatórios/métodos , Obstrução Intestinal/cirurgia , Tuberculoma/diagnóstico , Peritonite Tuberculosa/cirurgia , Tuberculose Pulmonar/diagnóstico , Colectomia/métodos , Colecistite Aguda , Abdome Agudo/cirurgiaRESUMO
INTRODUCTION: Central nervous system tuberculosis is a common chronic infection in developing countries, being the most frequent forms: tuberculous meningitis and intracranial tuberculosis. Extramedullary intradural tuberculosis is a rare entity with few cases described in the world literature, and is usually associated with a history of tuberculous meningitis or during antituberculosis treatment. CASE REPORT: A 17 years-old male patient, without history of tuberculosis, with subacute onset and progressive course of compressive myelopathy. Spinal magnetic resonance imaging revealed an intradural extramedullary mass lesion between the C4 and T8 spinal levels. Surgical resection of tuberculoma was realized, followed by chemotherapy. The histopathological study confirmed the diagnostic. CONCLUSIONS: Tuberculosis of the central nervous system is an entity of high incidence in developing countries, and intradural extramedullary tuberculoma should be included in the differential diagnosis of expansive spinal cord injuries, especially if the patient is young and there is a history of pulmonary tuberculosis or tuberculous meningitis. It is also important to take it into account as part of a paradoxical reaction after the initiation of specific treatment. Although surgical resection improves compressive medullary symptoms, medical therapy remains the mainstay in the treatment of tuberculomas.
TITLE: Tuberculoma intradural extramedular: descripcion de un caso clinico y revision de la bibliografia.Introduccion. La tuberculosis del sistema nervioso central es una infeccion cronica comun en paises en vias de desarrollo, y la meningitis tuberculosa y los tuberculomas intracraneales son las formas mas frecuentes. El tuberculoma intradural extramedular es una entidad poco frecuente, con pocos casos descritos en la bibliografia mundial, y por lo general se asocia a un antecedente de meningitis tuberculosa o durante el tratamiento antituberculoso. Caso clinico. Varon de 17 años, sin antecedente de tuberculosis, con cuadro clinico de una mielopatia compresiva de aparicion subaguda y curso progresivo, cuya neuroimagen evidencio una lesion extensa intradural extramedular. Se le realizo cura quirurgica mas laminectomia descompresiva en D4-D8 seguido de quimioterapia. El estudio histopatologico confirmo el diagnostico. Conclusiones. La tuberculosis del sistema nervioso central es una entidad de alta incidencia en nuestro medio, y el tuberculoma intradural extramedular deberia incluirse en el diagnostico diferencial de lesiones expansivas de la medula espinal, mas aun si el paciente es joven y existe el antecedente de tuberculosis pulmonar o meningitis tuberculosa. Asimismo, es importante tenerla en cuenta como parte de una reaccion paradojica despues del inicio del tratamiento especifico. Aunque la reseccion quirurgica mejora los sintomas compresivos medulares, la terapia medica continua siendo el pilar en el tratamiento de los tuberculomas.
Assuntos
Tuberculoma , Tuberculose Meníngea , Adolescente , Humanos , Masculino , Tuberculoma/diagnóstico , Tuberculoma/terapia , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/terapiaRESUMO
Tuberculous meningitis (TM), a common infectious disease of the central nervous system that is also seen in other types of tuberculosis infections, has higher mortality rates in young and middle-aged patients. TM is difficult to diagnose and treat owing to its non-specific clinical features and often atypical cerebrospinal fluid changes. Patients who present with focal neurologic signs, cough, low-grade fever and illness duration of more than 5 days, have intracalvarial abnormalities, and do not meet Thwaites' criterion findings should be diagnosed using computed tomography or magnetic resonance imaging. Mycobacterium infections can also be diagnosed by acid-fast staining of smears, cerebrospinal fluid culture, diagnostic polymerase chain reaction for Mycobacterium tuberculosis, and purified protein derivative test. To prevent TM misdiagnosis, clinicians must have sufficient knowledge of the clinical manifestations of tuberculosis. Appropriate application of tuberculosis chemotherapy drug principles, including early diagnosis and treatment, combination therapies, and consistent administration of treatment at appropriate dosages, can greatly reduce TM mortality rates and improve satisfactory treatment outcomes.
Assuntos
Diagnóstico Diferencial , Glioma/diagnóstico , Tuberculoma/diagnóstico , Tuberculose Meníngea/diagnóstico , Adulto , Sistema Nervoso Central/patologia , Feminino , Glioma/diagnóstico por imagem , Glioma/patologia , Glioma/terapia , Humanos , Imageamento por Ressonância Magnética , Mycobacterium tuberculosis/isolamento & purificação , Mycobacterium tuberculosis/patogenicidade , Reação em Cadeia da Polimerase , Tomografia Computadorizada por Raios X , Tuberculoma/diagnóstico por imagem , Tuberculoma/patologia , Tuberculoma/terapia , Tuberculose Meníngea/diagnóstico por imagem , Tuberculose Meníngea/patologia , Tuberculose Meníngea/terapiaRESUMO
We report a case of granulomatous mastitis caused by Mycobacterium tuberculosis in an immunocompetent woman with chronic inflammatory lesions of the breast. It was diagnosed by detection of mycobacteria DNA using polymerase chain reaction technique targeting IS6110 insertion element of M. tuberculosis complex in a paraffin-embedded histological specimen. The primary breast tuberculosis is rare, even in countries where the incidence and prevalence of pulmonary and extra pulmonary tuberculosis are high. It should be suspected in female patients with chronic granulomatous mastitis with no apparent cause. The cornerstone of treatment is antituberculous chemotherapy, and surgery is rarely required.
Assuntos
Mastite/diagnóstico , Tuberculoma/diagnóstico , Tuberculose Cutânea/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Antituberculosos/uso terapêutico , Biópsia , Neoplasias da Mama/diagnóstico , Elementos de DNA Transponíveis/genética , DNA Bacteriano/análise , Dermatomicoses/diagnóstico , Diagnóstico Diferencial , Etambutol/uso terapêutico , Reações Falso-Negativas , Feminino , Febre/etiologia , Humanos , Isoniazida/uso terapêutico , Mastite/patologia , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Pirazinamida/uso terapêutico , Rifampina/uso terapêutico , Dermatopatias Bacterianas/diagnóstico , Tuberculoma/patologia , Tuberculose Cutânea/patologia , Redução de PesoRESUMO
Se informa un caso de mastitis granulomatosa causada por Mycobacterium tuberculosis en una paciente inmunocompetente con lesiones inflamatorias crónicas de la mama, diagnosticada por la detección de ADN de la micobacteria mediante la técnica de reacción en cadena de la polimerasa de la secuencia de inserción IS6110 presente en el complejo M. tuberculosis , en una biopsia de mama embebida en parafina. La tuberculosis primaria de la mama es rara, incluso en países con alta prevalencia de tuberculosis, y debe sospecharse en pacientes con mastitis granulomatosa crónica de causa no clara. El pilar del tratamiento es la quimioterapia antituberculosa y, ocasionalmente, la cirugía.
We report a case of granulomatous mastitis caused by Mycobacterium tuberculosis in an immunocompetent woman with chronic inflammatory lesions of the breast. It was diagnosed by detection of mycobacteria DNA using polymerase chain reaction technique targeting IS6110 insertion element of M. tuberculosis complex in a paraffin-embedded histological specimen. The primary breast tuberculosis is rare, even in countries where the incidence and prevalence of pulmonary and extra pulmonary tuberculosis are high. It should be suspected in female patients with chronic granulomatous mastitis with no apparent cause. The cornerstone of treatment is antituberculous chemotherapy, and surgery is rarely required.
Assuntos
Adulto , Feminino , Humanos , Mastite/diagnóstico , Tuberculoma/diagnóstico , Tuberculose Cutânea/diagnóstico , Antibacterianos/uso terapêutico , Antituberculosos/uso terapêutico , Biópsia , Neoplasias da Mama/diagnóstico , Diagnóstico Diferencial , Elementos de DNA Transponíveis/genética , DNA Bacteriano/análise , Dermatomicoses/diagnóstico , Etambutol/uso terapêutico , Reações Falso-Negativas , Febre/etiologia , Isoniazida/uso terapêutico , Mastite/patologia , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Pirazinamida/uso terapêutico , Rifampina/uso terapêutico , Dermatopatias Bacterianas/diagnóstico , Tuberculoma/patologia , Tuberculose Cutânea/patologia , Redução de PesoAssuntos
Encefalopatias/complicações , Tuberculoma/complicações , Encefalopatias/induzido quimicamente , Encefalopatias/diagnóstico , Criança , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Doença de Hodgkin/tratamento farmacológico , Humanos , Imageamento por Ressonância Magnética , Masculino , Tuberculoma/induzido quimicamente , Tuberculoma/diagnósticoAssuntos
Faringite/etiologia , Tuberculose Laríngea/diagnóstico , Tuberculose Miliar/diagnóstico , Tuberculose Bucal/diagnóstico , Transtornos de Deglutição/etiologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Micoses/diagnóstico , Escarro/microbiologia , Tuberculoma/diagnóstico , Tuberculoma/patologia , Tuberculose Laríngea/complicações , Tuberculose dos Linfonodos/diagnóstico , Tuberculose Bucal/complicações , Distúrbios da Voz/etiologia , Redução de PesoRESUMO
Single enhancing brain lesions (SELs), mostly as a result of neurocysticercosis or tuberculosis, are a common cause of seizures. Ten patients with SELs caused by neurocysticercosis (n=6) or tuberculosis (n=4) were examined by proton magnetic resonance spectroscopy. Tuberculomas had a high peak of lipids, more choline, and less N-acetylaspartate and creatine. The choline/creatine ratio was greater than 1 in all tuberculomas but in none of the cysticerci. Magnetic resonance spectroscopy differentiates SELs caused by cysticercosis or tuberculosis and may avoid brain biopsies or unnecessary antituberculosis treatments.
Assuntos
Ácido Aspártico/análogos & derivados , Encefalopatias/parasitologia , Espectroscopia de Ressonância Magnética , Neurocisticercose/diagnóstico , Tuberculose do Sistema Nervoso Central/diagnóstico , Adolescente , Adulto , Ácido Aspártico/análise , Encefalopatias/diagnóstico , Colina/análise , Creatina/análise , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Ácido Láctico/análise , Lipídeos/análise , Masculino , Neurocisticercose/metabolismo , Tuberculoma/diagnóstico , Tuberculose do Sistema Nervoso Central/metabolismoRESUMO
Hepatic involvement by tuberculosis is a rare type of manifestation of the disease. There are several forms of clinical presentations. One of them is the hepatic tuberculoma in which we base our presentation. Given that hepatic tuberculoma is a rare entity and generally shows inespecific symptoms, it is rarely suspected by the clinical picture. The diagnosis of hepatic tuberculosis is generally done in the intraoperative or postoperative period by analyzing a specimen taken by laparoscopy or laparotomy during the study of a hepatic mass. Laboratory tests or image studies do not give pathognomonic information to conform the diagnosis. The cornerstone in the treatment of this pathology is the antituberculous therapy. Surgical or endoscopic interventions are occasionally required. The role of surgery in the treatment of this pathology is reserved for a few solitary lesions. Once the correct treatment is performed the outcome is favorable. We present 4 cases of hepatic tuberculoma with different imaging and clinical presentations.
Assuntos
Tuberculoma/diagnóstico , Tuberculose Hepática/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tuberculoma/cirurgia , Tuberculose Hepática/cirurgiaRESUMO
El compromiso hepático por tuberculosis es una manifestación poco frecuente de dicha enfermedad, pudiéndose manifestar clínicamente de diferentes formas. Una de ellas es el tuberculoma hepático, el cual motiva nuestra presentación. Dado a que el tuberculoma hepático es poco común y los enfermos se presentan generalmente con síntomas inespecíficos, la sospecha diagnóstica sólo con la clínica del enfermo es infrecuente. El diagnostico de tuberculosis hepática generalmente es intra o postquirúrgico mediante el análisis de la muestra realizada por medio de una laparotomía o laparoscopía en el estudio de una masa hepática. Asimismo, tanto en los análisis de laboratorio como en los estudios por imágenes no hay hallazgos patognomónicos de dicha patología. El pilar principal del tratamiento es la terapia antituberculosa. Ocasionalmente se requieren intervenciones quirúrgicas o endoscópicas. El papel de la cirurgía en el tratamiento se reserva para algunas lesiones solitarias. Una vez instaurando el tratamiento adecuado su prognóstico es favorable. Se comunican 4 casos de tuberculoma hepático con diversidad en cuanto a su presentación clínica e imagenológica.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Tuberculoma/diagnóstico , Tuberculose Hepática/diagnóstico , Tuberculoma/cirurgia , Tuberculose Hepática/cirurgiaRESUMO
El compromiso hepático por tuberculosis es una manifestación poco frecuente de dicha enfermedad, pudiéndose manifestar clínicamente de diferentes formas. Una de ellas es el tuberculoma hepático, el cual motiva nuestra presentación. Dado a que el tuberculoma hepático es poco común y los enfermos se presentan generalmente con síntomas inespecíficos, la sospecha diagnóstica sólo con la clínica del enfermo es infrecuente. El diagnostico de tuberculosis hepática generalmente es intra o postquirúrgico mediante el análisis de la muestra realizada por medio de una laparotomía o laparoscopía en el estudio de una masa hepática. Asimismo, tanto en los análisis de laboratorio como en los estudios por imágenes no hay hallazgos patognomónicos de dicha patología. El pilar principal del tratamiento es la terapia antituberculosa. Ocasionalmente se requieren intervenciones quirúrgicas o endoscópicas. El papel de la cirurgía en el tratamiento se reserva para algunas lesiones solitarias. Una vez instaurando el tratamiento adecuado su prognóstico es favorable. Se comunican 4 casos de tuberculoma hepático con diversidad en cuanto a su presentación clínica e imagenológica.(AU)