Asymptomatic pons tuberculoma in an infant with miliary tuberculosis.

Miliary tuberculosis is caused by the hematogenous spread of Mycobacterium tuberculosis and consists of 1.5% of all tuberculosis cases. It is seen mostly in infants because of the immature immune system, and central nervous system CNS involvement is not rare. Tuberculomas are rarely seen in the localized form of CNS tuberculosis, and only 4% are localized in the brain stem. We report a 4.5-month-old infant who deteriorated during follow-up with the diagnosis of cytomegalovirus pneumonia, and afterwards received the diagnosis of miliary tuberculosis. Although the baby had no neurologic abnormality and cerebrospinal fluid findings were normal, cranial MRI revealed contrast enhanced nodular lesions in pons, cerebellum, and right parietal region. The case is presented to intensify the importance of CNS investigation even if the patient with miliary tuberculosis has no neurologic finding.

Clinical features of extrapulmonary tuberculosis in children.

OBJECTIVE: To review the clinical features of the extrapulmonary tuberculosis (TB) in children. METHODS: Sixty-four children with extrapulmonary TB followed in Ankara Social Security Children's Hospital between June 1995 and May 2003 were reviewed. RESULTS: The mean age was 7.5 +/- 4.1 years. The most commonly involved sites were the central nervous system [(CNS) 16 cases] and pleura (14 cases). Aside from this, 10 children had a diagnosis of miliary TB. Abdominal TB (median age of 12 years) and pleural effusion (median age of 10.9 years) were mostly seen in older children while miliary TB was encountered more frequently in younger children (median age 2.5 years). A positive family history of active TB was detected in 39% of the cases. There was consanguinity between parents in 23 (35.9%) of the cases. Twenty-five (39%) cases had no Bacillus Calmette-Guerin vaccination scar. One case with CNS TB expired. Sequelae observed during the follow up were; motor-mental retardation in 3 cases, hemiparesis in 2 cases, strabismus in one case with CNS TB and vertebral deformation in 2 cases with Pott's disease. CONCLUSION: Severe forms such as CNS and miliary TB constituted an important percentage of childhood extrapulmonary TB cases.

Asymptomatic pons tuberculoma in an infant with miliary tuberculosis.

Miliary tuberculosis is caused by the hematogenous spread of Mycobacterium tuberculosis and consists of 1.5% of all tuberculosis cases. It is seen mostly in infants because of the immature immune system, and central nervous system (CNS) involvement is not rare. Tuberculomas are rarely seen in the localized form of CNS tuberculosis, and only 4% are localized in the brain stem. We report a 4.5-month-old infant who deteriorated during follow-up with the diagnosis of cytomegalovirus pneumonia, and afterwards received the diagnosis of miliary tuberculosis. Although the baby had no neurologic abnormality and cerebrospinal fluid findings were normal, cranial MRI revealed contrast enhanced nodular lesions in pons, cerebellum, and right parietal region. The case is presented to intensify the importance of CNS investigation even if the patient with miliary tuberculosis has no neurologic finding.

Herpetic finger infection.

We present a case of herpetic gingivostomatitis and finger infection. Vesicular hand lesions may result from autoinoculation of oral herpes simplex virus (HSV) infection in children, which may be evident or asymptomatic.