Challenges of the diagnosis and treatment of generalized pulmonary tuberculosis with brain damage in a 25 – year old patient

Challenges of the diagnosis and treatment of generalized pulmonary tuberculosis with brain damage in a 25 – year old patient

Giller D.B., Beresneva R.E., Lazareva Ya.V., Romenko M.A., Scsherbakova G.V., Enilenis I.I., Kesaev O.Sh., Pyatenko E.A.

Purpose. To show the difficulty of central nervous system tuberculosis (TB) diagnosis, specifically brain tuberculoma.

Materials. In December 2009, during the first pregnancy, the patient had tuberculous pleurisy on the left. After delivery, she received a chemotherapy course, but without CT control. As a result, remaining pleural encysting was not revealed. Three years later, neurological symptoms have appeared after the second birth. An MRI scan revealed a volume brain formation then a caesarean section (29 weeks) and partial removal of the brain mass formation using neurophysiological monitoring and ultrasound navigation were performed. Histologically brain tuberculoma was verified.

Results. The patient was routed to a tuberculosis hospital, where chest CT scan revealed focal pulmonary tuberculosis and encysted pleural empyema on the left 20x15x5 cm in size. After the chemotherapy course, the patient underwent a pleurectomy with partial resection of the left lung. Further observation of the patient for 4 years showed clinical cure.

Despite the ability to visualize the brain in some cases, the definite diagnosis can only be made after a biopsy. The necessity of surgical treatment in chronic empyema treatment does not cause anyone to doubt, but the presence of generalization with brain damage and severe brain symptoms are considered as contraindication to radical surgery by the majority of phthisiosurgeons.

Conclusion. We considered pleurectomy to be absolutely indicated, taking into account, that purulent focus served as the source of hematogenous generalization of the process. Anamnesis shows insufficient radiological control after a course of pleurisy treatment in 2009. If CT were performed during that period, the formation of encysted empyema would not have gone unnoticed, pleurectomy would has been performed timely, and generalization of the process would have been avoided.

1 - I.M. Sechenov First Moscow State Medical University (Sechenov University).

2 - SMIC FTI, Ministry of Healthcare.

Moscow, Russia.

 

Keywords: Tuberculosis, CT, Central Nervous System Tuberculosis, Empyema.


Corresponding author:  Giller D.B., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Giller D.B., Beresneva R.E., Lazareva Ya.V., Romenko M.A., Scsherbakova G.V., Enilenis I.I., Kesaev O.Sh., Pyatenko E.A. Challenges of the diagnosis and treatment of generalized pulmonary tuberculosis with brain damage in a 25 – year old patient. REJR 2019; 9(2):246-254. DOI:10.21569/2222-7415-2019-9-2-246-254.

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Received:        22.05.19 Accepted:       14.06.19