Abstract
Multiple cerebral tuberculomas are now very rare. We report the case of a young man with an 8-month history of headache, febricula and abscess of the left tibiotarsal joint, which was found to contain mycobacterium tuberculosis. Chest X-rays revealed miliariform dissemination to both lungs while CT and MR brain scans revealed numerous small nodules, especially in the posterior cranial fossa. Despite anti-tuberculosis therapy the patient developed a right pyramidal hemisyndrome and intracranial hypertension. The inclusion of rifabutin in the treatment schedule was followed by rapid improvement and a year later the patient was in good health and free from cerebral and pulmonary lesions. The interest of the case lies in the multiplicity of sites of the TB process in a non immunodepressed patient, the dissemination to the CNS without meningeal involvement, the resistance to standard antimycobacterials and the swift response to rifabutin.
Sommario
I tubercolomi cerebrali multipli sono assai raramente osservati; in letteratura sono documentati circa trenta casi.
Descriviamo il caso di un giovane uomo che giunge all'osservazione con una storia di otto mesi di cefalea, febbricola, ascesso della tibio-tarsica sinistra.
Operato l'ascesso, si riscontra mycobacterium tubercolosis nel materiale asportato. La radiografia del torace evidenzia disseminazione miliariforme ad entrambi i polmoni. TAC ed RMN cerebrali documentano numerosissimi piccoli noduli coinvolgenti specialmente la fosse posteriore.
Nonostante instaurazione di terapia antimicobatterica classica, compare emisindrome piramidale destra con ipertensione endocranica.
Introducendo Rifabutina si osserva rapido miglioramento della situazione. Dopo un anno di terapia il paziente è il buone condizioni; le lesioni cerebrali e polmonari scomparse.
L'interesse del caso è determinato dalla pluricentricità dei processi TBC in paziente non-immunodepresso, dalla disseminazione tubercolare al nevrasse senza interessamento meningeo e dalla resistenza ai classici antimicobatterici, con pronta risposta alla Rifabutina.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
De Angelis L.:Intracranial tuberculoma: case report and review of the literature. Neurology 31: 1133–1136, 1981.
Jinkins J.R., Al-Kawi M.Z., Bashir R.:Dynamic computed tomography of cerebral parenchymal tuberculomata. Neuroradiology 29: 523–529, 1987.
Kingsley D.P.E., Hendrickse W.A., Kendall B.E., Swash M., Singh V.:Tubercolous meningitis: role of CT in management and prognosis. J. Neurol. Neurosurg. Psychiatry 50: 30–36, 1987.
Maurice-Williams R.S.:Tuberculomas of the brain in Britain. J. Postgrad. Med. 48: 678–681, 1972.
Mayers M.M., Kaufman D.M., Miller M.H.:Recent cases of intracranial tuberculomas. Neurology 28: 256–260, 1978.
Price H.I., Danziger A.:Computed tomography in cranial tuberculosis. Am. J. Roentgenol. 130: 769–771, 1978.
Van Dyk A.:CT of intracranial tuberculomas with specific reference to the “target sign”. Neuroradiology 30: 329–336, 1988.
Venger B.H., Dion F.M., Rouah E., Handel S.F.:M.R. Imaging of pontine tuberculoma. Am. J. Neuroradiol. 8: 1149–1150, 1987.
Vengsarkar U.S., Pisipaty R.P., Parekh B., Panchal V.G., Shetty M.N.:Intracranial tuberculoma and the CT scan. J. Neurosurg. 64: 568–574, 1986.
Whelan M.A., Stern J.:Intracranial tuberculoma.Neuroradiology.138:75–81, 1981.
Wilson S.A.K.:Neurotuberculosis. in Bruce A.N. ed. Neurology, vol. 1, Chap. 19. Baltimore: Williams & Wilkins; 1955; 1.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Riva, M., Crippa, S., Di Palma, F. et al. Disseminated tuberculosis of the central nervous system responsive to rifabutin. Ital J Neuro Sci 11, 163–169 (1990). https://doi.org/10.1007/BF02335560
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02335560