BACKGROUND: Paradoxical intracranial tuberculoma is tuberculoma that developed or was enlarged during antituberculous therapy. The course of the disease or effective treatment are not well known. METHOD: Patients who developed intracranial tuberculoma or an enlarged tuberculoma during antituberculous therapy were investigated. Ten patients were enrolled. RESULTS: Paradoxical intracranial tuberculoma was detected 67.9 days after antituberculous therapy. The symptoms worsened over a period of 102.3 days. Improvement was noted after 165.4 days. Four patients recovered on the brain image and 4 recovered clinically. The CSF findings showed that the paradoxical tuberculomas had developed or were aggravated, the CSF findings was aggravated. CONCLUSION: Paradoxical intracranial tuberculoma can develop without specific symptoms. Paradoxical intracranial tuberculoma may not be a paradoxical response and may be a natural course of intracranial tuberculosis or a natural response to antituberculous therapy.
Brain ; Drug Therapy* ; Humans ; Tuberculoma ; Tuberculoma, Intracranial ; Tuberculosis

Although tuberculomas of the brain and the spinal cord were recorded in many case reports, that of the peripheral nerve was extremely rare and only two cases were reported in the literature(in India). These reported tuberculomas were found in the ulnar nerve, that were treated by operative removal and postoperative antituberculous chemotherapy. We have recently experienced a case of tuberculoma of the ulnar nerve that was operatively removed to be confirmed by microscopic examination. We report this case with brief review of the articles.
Brain ; Drug Therapy ; Peripheral Nerves ; Spinal Cord ; Tuberculoma* ; Ulnar Nerve*

The authors describe a case of tuberculous abscess of the cerebellum that originating probably from pulmonary lesion. The development of such a lesion indicates a persistence of infection and an immunological breakdown which may party have been due to unsatisfactory chemotherapy and protein malnutrition. Tuberculous brain abscess, an encapsulated collection of pus containing viable tubercle bacilli, is quite rare and it is different from tuberculoma in several points. Only five cases of tuberculous abscess have been fully documented and bacteriologically confirmed. The clinical, laboratory, and histopathological findings of those reported cases and the author's have been discussed.
Abscess ; Brain Abscess* ; Brain* ; Cerebellum* ; Drug Therapy ; Malnutrition ; Suppuration ; Tuberculoma

OBJECTIVE: Spinal intramedullary tuberculoma (SIMT) is rare, accounting for 2/100,000 cases of tuberculosis and only 0.2% of all cases of central nervous system(CNS) tuberculosis. We share our experiences of 11 cases of this entity for improving diagnosis and conceptualize the management of this rare disease. METHODS: The clinical profile, radiological data and management of 11 cases of SIMT which were managed either conservatively or by surgical intervention during last 27 years (1987-2014) were analysed. RESULTS: Male:female ratio was 1.75:1. Five cases had associated pulmonary Koch's. Most common site was thoracic cord. Two cases had concurrent multiple intracranial tuberculoma. Most common presentation was paraparesis. X-ray myelography was performed in two patients in the initial period of study suggesting intramedullary pathology. In the subsequent nine cases who had magnetic resonance imaging (MRI), seven showed typical "target sign" and conglomerate ring lesion. Out of 8 surgically managed patients, 6 cases improved rapidly and in 2 patients gradual improvement was seen in follow-up. Most common indication of surgical excision was rapid neurological deterioration followed by diagnosis in doubt. Histopathology confirmed tuberculous etiology of the intramedullary lesion in all. Clinical and radiological improvement was seen in all 3 conservatively managed patients in follow-up. CONCLUSION: MRI findings of SIMT were specific and proven histologically correct. Surgical intervention may be indicated if there is no response to chemotherapy, the diagnosis is in doubt, or there is a rapid deterioration in neurological function because surgical outcome is good in these circumstances.
Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Myelography ; Paraparesis ; Pathology ; Rare Diseases ; Tuberculoma* ; Tuberculoma, Intracranial ; Tuberculosis

Epidural tuberculoma without bony involvement was first reported by Rao et al. in 1971; however, extraosseous spinal epidural tuberculoma and tuberculous infection of the cauda equina have never been reported. We experienced a case of epidural tuberculoma without bony involvement, which was diagnosed by decompression and biopsy, and treated with combined antituberculous chemotherapy. It resembled herniated nucleus pulposus at the L4-5 level, based on its clinical features, a physical examination, myelography and computed tomography. In the course of antituberculous medication, tuberculosis of the cauda equina occurred, which caused paraparesis. Herein, this case is reported in terms of its treatment and clinical course, with a review of the literature.
Biopsy ; Cauda Equina* ; Decompression ; Drug Therapy ; Epidural Space ; Myelography ; Paraparesis ; Physical Examination ; Spine* ; Tuberculoma* ; Tuberculosis

Antitubercular Agents ; therapeutic use ; Brain Abscess ; drug therapy ; Humans ; Steroids ; therapeutic use ; Treatment Failure ; Tuberculoma, Intracranial ; drug therapy

Intradural extramedullary (IDEM) tuberculoma of the spinal cord is uncommon entity and moreover, few reports have been documented on concurrent IDEM and intracranial tuberculomas. Authors report a case of IDEM spinal tuberculoma having intracranial lesion simultaneously. A 49-year-old woman suffered from paraparesis and urinary incontinence while being given medical treatment for tuberculous meningitis. Magnetic resonance imaging (MRI) revealed an IDEM mass lesion between the T1 and T2 spinal levels, and multiple intracranial tuberculous granulomas. Surgical resection of the IDEM tuberculoma followed by anti-tuberculous medication resulted in good outcome.
Brain/radiography ; Case Report ; Female ; Follow-Up Studies ; Human ; Magnetic Resonance Imaging ; Middle Age ; Mycobacterium tuberculosis/isolation & purification ; Spinal Cord Diseases/radiography* ; Tuberculoma/surgery ; Tuberculoma/radiography ; Tuberculoma/drug therapy ; Tuberculoma/complications* ; Tuberculosis, Meningeal/surgery ; Tuberculosis, Meningeal/radiography ; Tuberculosis, Meningeal/drug therapy ; Tuberculosis, Meningeal/complications*

The solitary form of primary hepatic tuberculosis is a rare disease. We report an unusual case of primary solitary hepatic tuberculosis treated with surgical resection and second-line antituberculosis chemotherapy due to the recurrence after first-line antituberculosis chemotherapy alone. A 36-year-old man was presented with right upper abdominal discomfort, chills and weight loss for 2 months. Computerized tomography demonstrated the solitary space occupying lesion on the left lobe of liver suggesting a malignant disease. The open biopsy revealed chronic granulomatous inflammation with multinucleated giant cells and caseous necrosis. The patient was treated with antituberculosis chemotherapy for nine months and eighteen months respectively with the interval of eighteen months. But the hepatic lesion had become larger and symptoms were aggravated after the discontinuation of therapy. He underwent surgical excision of the lesioin. With second-line antituberculosis chemotherapy, the symptoms improved in postoperative days. Twenty four months later, no evidence of recurrence was noted in symptoms, laboratory findings and imaging studies.
Adult ; Biopsy ; Chills ; Drug Therapy* ; Giant Cells ; Humans ; Inflammation ; Liver* ; Necrosis ; Rare Diseases ; Recurrence ; Tuberculoma* ; Tuberculosis, Hepatic ; Weight Loss

BACKGROUND: A pulmonary tuberculoma is one of the most common causes of a solitary pulmonary lesion. Treating a tuberculoma is still controversial and there are few reports on antituberculosis chemotherapy. In this study, the clinical findings and changes in the size of tuberculomas on a radiograph after completing antiuberculosis chemotherapy was investigated. METHODS: The medical records, an chest radiographs of 18 pulmonary tuberculoma patients who were admitted to the Gachon medical school, Ghil medical center between April 1998 and August 2001, were reviewed. The symptomatic changes were recorded and the size of the tuberculomasl following treatment were compared. To compare the size, the long distance of each tuberculoma on the chest radiographs were measured and the additional radiological findings of calcification, satellite nodules and cavities were investigated. RESULTS: Fifteen patients were men and 3 were women. The median age was 46(24-74). Among these 18 patients, 14 patients had clinical symptoms. The other 4 patients were diagnosed incidentally as during a routine chest radiograph. The mean size of the tuberculomas on the initial plain chest film was 4.3+/-2.3cm(range : 1.7-10cm)and after 6 months treatment, it had decreased to 1.68+/-2.00cm(range : 1.5-6.5cm)(P<0.05). At least 6 months of antituberculosis chemotherapy resulted in the findings of a tuberculoma with a disappearance in 9, a decreased size in 4, and no change in 5 on the chest radiograph. Calcifications were found in 3 patients on the initial chest film and the chest CT and all calcified tuberculomas had disappeared after treatment. CONCLUSIONS: A lthough a pulmonary tuberculoma can remain as an inactive lesion for a long time, if it is confirmed by pathological or bacteriological methods, antituberculosis chemotherapy will be beneficial despite the presence of calcification.
Drug Therapy ; Female ; Humans ; Male ; Medical Records ; Radiography, Thoracic ; Schools, Medical ; Thorax ; Tomography, X-Ray Computed ; Tuberculoma*

To present CT and clinical features of active tuberculomas, we analyzed retrospectively CT findings of 14 tuberculomas (n=14) in 13 patients which appeared as solitary pulmonary nodules on plain radiographs and evaluated the response of tuberculomas to antituberculous chemotherapy. Nine tuberculomas (64%) were ovoid in shape and 10 (72%) showed smooth margin. Twelve(86%) tuberculomas were shown as low density lesions on unenhanced or enhanced CT scans. Calcification and cavitation were noted in three (21%) and eight (57%) tuberculomas respectively. Seven (50%) tuberculomas were accompanied by satellite nodules. Acid-fast bacilli (AFB) was positive in all tuberculomas in sputum, lavage fluid, or percutaneous transhoracic needle aspiration (PTNA). Smear and culture of lavage fluid and PTNA aspirate were superior to the detection of AFB than sputum examination. Follow-up study with antituberculous chemotherapy in 14 tuberculomas resulted in complete disappearance in three, decrease in size in seven, and no visible change in the remaining four. These observations suggest that tuberculomas are well-defined, ovoid, and low-density nodules containing calcifications and/or cavitations. Tuberculomas are relatively indolent even with threatment.
Drug Therapy ; Follow-Up Studies ; Humans ; Needles ; Retrospective Studies ; Solitary Pulmonary Nodule ; Sputum ; Therapeutic Irrigation ; Tomography, X-Ray Computed ; Tuberculoma*