Yanlış Tanı Almış İntrakraniyal Tüberkülom

Yıl 2015, , 72 - 76, 01.06.2015

Ömer Kılıç , Olcay Ünver Sibel Laçinel Zehra İşık Haşıloğlu Serap Uysal Haluk Çokuğraş Yıldız Camcıoğlu Necla Akçakaya

https://doi.org/10.4274/jcp.36844

Öz

Merkezi sinir sistemi MSS tüberkülozu nadir görülmesine rağmen tedavi gecikirse nörolojik sekellere ve mortaliteye yol açmaktadır. Dokuz yaşında kız hasta konvülziyon geçirme yakınmasıyla kliniğimize getirildi. Konvülziyonları devam ettiği için çekilen kranyal manyetik rezonans görüntüleme MRG görüntülemelerine göre akut disemine ensefalomyelit düşünülerek steroid tedavisi verilmiş. Konvülziyonlarının tekrarlaması nedeniyle tarafımıza getirilen hastanın muayenesinde bilateral papilödem dışında patolojik muayene bulgusu saptanmadı. Tüberkülin deri testi 19 mm bulundu. Tüberkülin deri testi pozitifliği, tüberkülozlu bireyle temas öyküsü, toraks ve kranyal görüntülemelerde tüberkülozla uyumlu bulgular, hastanın semptom ve muayene bulguları ile birlikte değerlendirilerek intrakraniyal tüberkülom tanısı kondu. Antitüberküloz tedavi ve deksametazon tedavisi başlandı. Hastanın iki yıllık izleminde herhangi bir komplikasyon gözlenmedi. İntrakraniyal tüberkülom MSS tüberkülozunun nadir rastlanan, morbidite ve mortalitesi yüksek bir formudur. Klinik, laboratuvar ve görüntüleme yöntemlerinin spesifik olmaması nedeniyle, MMS patolojilerinde ayırıcı tanıda akılda tutulması gerekir. Erken tanı ve tedavi iyi prognoz açısından önemlidir

Anahtar Kelimeler

Merkezi sinir sistemi tüberkülozu, intrakraniyal tüberkülom, akut disemine ensefalomyelit

Misdiagnosed Intracranial Tuberculoma

Öz

Although tuberculosis of the central nervous system CNS is rarely seen, it may cause neurological sequelae and mortality if treatment is delayed. A nineyear-old girl was admitted to our clinic with the complaint of convulsion. Since her convulsions were persistent, steroid treatment had been administered for acute disseminated encephalomyelitis based on the cranial magnetic resonance imaging MRI . In the examination of the patient, who was brought to our clinic due to recurrent convulsions, no pathological finding was detected except for bilateral papilledema. The tuberculin skin test revealed an induration of 19 mm. The positive tuberculin skin test, history of contact with an individual with tuberculosis, and findings indicating tuberculosis in the thorax and cranial imaging were assessed together with the symptoms and examination findings of the patient, and intracranial tuberculoma diagnosis was made. Antituberculosis treatment and dexamethasone treatment were initiated. No complications were observed in the two-year follow-up of the patient. Intracranial tuberculoma is a rare form of CNS tuberculosis with high rates of morbidity and mortality. Because clinical, laboratory, and imaging findings are nonspecific, it should be considered in the differential diagnosis of CNS disorders. Early diagnosis and treatment are crucial for a better prognosis

Anahtar Kelimeler

Central nervous system tuberculosis, intracranial tuberculoma, acute disseminated encephalomyelitis

Kaynakça

• 1. Kumar D, Watson JM, Charlett A, Nicholas S, Darbyshire JH. Tuberculosis in England and Wales in 1993: results of a national survey. Thorax 1997;52:1060-7.
• 2. Yaramiş A, Gurkan F, Elevli M, Söker M, Haspolat K, Kirbaş G, et al. Central nervous system tuberculosis in children: a review of 214 cases. Pediatrics 1998;102(5):E49.
• 3. Wasay M, Moolani MK, Zaheer J, Kheleani BA, Smego RA, Sarwari RA. Prognostic indicators in patients with intracranial tuberculoma: a review of 102 cases. J Pak Med Assoc 2004;54:83-7.
• 4. Farinha NJ, Razali KA, Holzel H, Morgan G, Novelli VM. Tuberculosis of the central nervous system in children: a 20-year survey. J Infect 2000;41:61-8.
• 5. Wender M. Acute disseminated encephalomyelitis (ADEM). J Neuroimmunol 2011;231;92-9.
• 6. Poyrazoğlu HG, Canpolat M, Gümüş H, Per H, Kumandaş S, Doğanay S. A Case of Acute Disseminated Encephalomyelitis Secondary to Mycoplasma pneumoniae Infection. Turkiye Klinikleri J Pediatr 2012;21:247-51.
• 7. Rich AR, McCordock HA. The pathogenesis of tuberculous meningitis. Bull Johns Hopkins Hosp 1933;52:5-37.
• 8. Lwakatare FA, Gabone J. Imaging features of brain tuberculoma in Tanzania: case report and literature review. Afr Health Sci 2003;3:131-5.
• 9. Harisinghani MG, McLoud TC, Shepard JA, Ko JP, Shroff MM, Mueller PR. Tuberculosis from head to toe. Radiographics 2000;20:449-70.
• 10. Bayindir C, Mete O, Bilgic B. Retrospective study of 23 pathologically proven cases of central nervous system tuberculomas. Clin Neurol Neurosurg 2006;108:353-7.
• 11. Luthra G, Parihar A, Nath K, Jaiswal S, Prasad KN, Husain N, et al. Comparative evaluation of fungal, tubercular, and pyogenic brain abscesses with conventional and diffusion MR imaging and proton MR spectroscopy. AJNR Am J Neuroradiol 2007;28:1332-8.
• 12. Ersahin M, Hakan T, Ayan E, Berkman Z, Ekinci O, Ceran N, et al. Diagnostic and therapeutic role of CT-guided stereotactic surgery in the management of intracranial tuberculomas. Turk Neurosurg 2010;20:295-302.
• 13. Morgado C, Ruivo N. Imaging meningo-encephalic tuberculosis. Eur J Radiol 2005;55:188-92.
• 14. Okada H, Yoshioka K. Acute disseminated encephalomyelitis associated with meningitis due to Mycobacterium intracellulare. Intern Med 2010;49:2113-6.
• 15. Masoodi I, Farooq O, Ahmad I, Bhat MY, Ahmad N, Wani HU, et al. Acute disseminated encephalomyelitis as the first presentation of CNS tuberculosis: report of a case with brief review. Ger Med Sci 2010;8:32.
• 16. Özhan M, Tiryaki Aydoğan Ö, Kumral E. Acute disseminated encephalomyelitis following pulmonary tuberculosis. Turkish Respir J 2005;6:161-3.
• 17. Centers for Disease Control and Prevention. Treatment of Tuberculosis, American Thoracic Society, CDC, and Infectious Diseases Society of America. MMWR 2003;52:69.
• 18. Hristea A, Constantinescu RV, Exergian F, Arama V, Besleaga M, Tanasescu R. Paraplegia due to non-osseous spinal tuberculosis: report of three cases and review of the literature. Int J Infect Dis 2008;12:425-9.
• 19. Roca B. Intradural extramedullary tuberculoma of the spinal cord: a review of reported cases. J Infect 2005;50:425-31.
• 20. Chambers ST, Hendrickse WA, Record C, Rudge P, Smith H. Paradoxical expansion of intracranial tuberculomas during chemotherapy. Lancet 1984;2:181-4.