RESUMEN
Miliary tuberculosis after intravesical Calmette-Guerin bacilli (BCG) therapy is rare. To date, only 23 cases have been reported. We describe the case of a patient on hemodialysis, review the literature, and call attention to the potential hazard of intravesical BCG therapy in patients on renal replacement therapy and the value of polymerase chain reaction-based methods for early diagnosis of this serious complication.
Asunto(s)
Terapia Biológica/efectos adversos , Terapia Biológica/métodos , Mycobacterium bovis/aislamiento & purificación , Tuberculosis Miliar/diagnóstico , Tuberculosis Pulmonar/diagnóstico , Neoplasias de la Vejiga Urinaria/terapia , Administración Intravesical , Humanos , Masculino , Persona de Mediana Edad , Radiografía Torácica , Tomografía Computarizada por Rayos X , Tuberculosis Miliar/patología , Tuberculosis Pulmonar/patologíaAsunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Artritis Infecciosa/etiología , Artritis/tratamiento farmacológico , Enfermedad de Crohn/complicaciones , Inmunosupresores/efectos adversos , Tuberculosis Osteoarticular/etiología , Adalimumab , Anticuerpos Monoclonales Humanizados/uso terapéutico , Artritis/microbiología , Artritis Infecciosa/microbiología , Enfermedad de Crohn/tratamiento farmacológico , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis , Tuberculosis Miliar/patología , Tuberculosis Osteoarticular/microbiologíaRESUMEN
Brainstem tuberculoma is an uncommon entity especially in the immunocompetent adult. The authors describe the case of a 32-year-old immunocompetent woman with no systemic signs or symptoms of tuberculosis, presenting with sudden-onset hemiparesis and diplopia. MRI of brain revealed an enhancing lesion in the midbrain and thalamus. Cerebrospinal fluid examination was normal. Chest imaging was consistent with miliary tuberculosis; however initial expectorated sputum was culture negative. Bronchosopy sputum culture was positive for Mycobacterium tuberculosis. Her PPD was negative. Patient became asymptomatic with treatment for tuberculosis and follow-up MRI showed complete resolution of the lesion a year later. We conclude that a high index of suspicion is essential to make an early diagnosis of intracranial tuberculoma, since often, traditional TB tests like PPD and sputum examinations can be negative.
Asunto(s)
Tronco Encefálico/patología , Inmunocompetencia , Tuberculoma Intracraneal/patología , Adulto , Antituberculosos/uso terapéutico , Broncoscopía , Femenino , Humanos , Imagen por Resonancia Magnética , Esputo/microbiología , Tegmento Mesencefálico/patología , Tálamo/patología , Prueba de Tuberculina , Tuberculoma Intracraneal/tratamiento farmacológico , Tuberculosis Miliar/complicaciones , Tuberculosis Miliar/patologíaRESUMEN
We evaluated a 28-year-old female with a unilateral hearing loss of unusual pathogenesis, that of central nervous system miliary tuberculosis. Audiologic and otologic findings were consistent with left retrocochlear disorder, characterized by a profound hearing sensitivity loss, absent acoustic reflexes, normal otoacoustic emissions, and the presence of only wave I of the auditory brainstem response. Imaging studies revealed the presence of multiple punctate lesions, one of which was extra-axial and located at the left cerebellopontine angle. The pattern of audiometric test results, particularly the combination of normal otoacoustic emissions and profound hearing sensitivity loss, contributed importantly to the investigative sequence leading to the final diagnosis.