Idiopathic granulomatous hypophysitis (IGH), a rare disease, requires differentiation from more common mass lesions of the sella such as pituitary adenoma, craniopharyngioma, Rathke's cleft cyst, or pituitary tuberculoma. IGH usually presents with an insidious onset of visual defects and headaches. On the other hand, rapid onset of neurologic and visual symptoms in an IGH patient is exceptionally rare. Here, we present a biopsy-proven case of IGH with rapid onset and satisfactory outcome after high dose steroid treatment.
Adult ; Autoimmune Hypophysitis ; Craniopharyngioma ; Endoscopy ; Glucocorticoids ; Hand ; Headache ; Humans ; Pituitary Gland ; Pituitary Neoplasms ; Rare Diseases ; Sella Turcica ; Tuberculoma

Nearly one third of the world's population have active or latent tuberculosis, resulting in 1.5 million deaths annually. Tuberculosis involving the peripheral nerve is difficult to detect. Sural nerve tuberculoma is an extremely rare case of tuberculous involvement of the peripheral nerve that has attracted the attention of physicians. This paper reports a patient with sural nerve tuberculoma. A 58-year-old female patient presented with a palpable mass on the posterolateral calf with progressive tingling sensation on the distal area. The patient had no history of trauma and it was unclear whether the patient had any contact with individuals with active tuberculosis. The histopathologic findings revealed a granuloma-like lesion with caseous necrosis that was compatible with tuberculoma.
Female ; Humans ; Latent Tuberculosis ; Middle Aged ; Necrosis ; Peripheral Nerves ; Sensation ; Sural Nerve ; Tuberculoma ; Tuberculosis

Tracheal tumors are rare and difficult to diagnose. Moreover, delays in diagnosis are very common because the symptoms are nonspecific. As a result, tracheal tumors are commonly mistreated as chronic obstructive pulmonary disease or bronchial asthma. We report a case of a 49-year-old male who presented with a 3-month history of dyspnea and cough. Chest computed tomography scan showed a 1.5×1.3 cm homogenous tumor originating from the right lateral wall of the tracheobronchial angle into the tracheal lumen as well as a 0.5×0.4 cm round nodular lesion at the right upper lobe with multiple mediastinal lymph nodes enlargement. Bronchoscopic findings revealed a broad-based, polypoid lesion nearly obstructing the airway of the right main bronchus. The patient was diagnosed with pleomorphic adenoma which is the most common benign tumor of the salivary glands, but rarely appears in the trachea. Upon surgery, tracheal pleomorphic adenoma and co-existing active pulmonary tuberculoma that had been mistreated as bronchial asthma over 3 months was revealed. Following surgery, the patient underwent anti-tuberculosis treatment. No recurrence has been detected in the 3 years since treatment and the patient is now asymptomatic.
Adenoma, Pleomorphic ; Asthma ; Bronchi ; Cough ; Diagnosis ; Dyspnea ; Humans ; Lymph Nodes ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; Recurrence ; Salivary Glands ; Thorax ; Trachea ; Tracheal Neoplasms ; Tuberculoma ; Tuberculosis, Pulmonary

BACKGROUND: Miliary tuberculosis (TB) can cause diagnostic confusion for clinicians because its radiological appearance can resemble that of metastatic cancer. CASE REPORT: Here, we describe the case of a 72-yearold woman with miliary TB mimicking brain metastasis from renal cell carcinoma. The patient visited our clinic because of dysarthria and sluggish speech. A metastatic cancer such as renal cell carcinoma or brain tumor was suspected. However, the patient was diagnosed with miliary TB associated with multiple intracranial tuberculomas and a subsequent paradoxical response to anti-TB therapy. CONCLUSION: Clinicians should be aware that miliary TB can mimic metastatic cancer even in older people, especially in TB-endemic regions.
Brain Neoplasms ; Brain ; Carcinoma, Renal Cell ; Dysarthria ; Female ; Humans ; Neoplasm Metastasis ; Tuberculoma, Intracranial ; Tuberculosis, Miliary

Tuberculosis can occur in various organ systems and may present with diverse manifestations. We report an unusual case of mediastinal tuberculoma in a 3-month-old boy who presented to the hospital after experiencing fever, cough, and progressive pneumonia for two weeks. The chest computed tomography scan indicated a mediastinal mass suggesting lymphoma. However, histological analysis confirmed that the mass was caused by tuberculosis. The present report describes the delayed diagnosis of a disease due to an uncommon presentation. Misdiagnosing unusual cases of tuberculosis results in treatment delays and may lead to an increase in morbidity. Therefore, we suggest that tuberculosis should be included in the differential diagnosis for children presenting with a mediastinal mass, especially in areas with a high prevalence of tuberculosis.
Child ; Cough ; Delayed Diagnosis ; Diagnosis, Differential ; Fever ; Humans ; Infant* ; Lymphoma ; Male ; Mediastinum ; Pneumonia ; Prevalence ; Thorax ; Tuberculoma ; Tuberculosis*

No abstract available.
Brain ; Tuberculoma

In Korea, tuberculosis is still common disease. Central nervous system tuberculosis can manifest in a variety of forms, including tuberculous meningitis, tuberculous cerebritis, tuberculoma, tuberculous abscess, and miliary tuberculosis. Although intra-axial tuberculomas are the more common type of CNS tuberculosis, extra-axial lesions are rarely encountered. En plaque tuberculoma is an extremely rare presentation of intracranial tuberculosis with mimicking primary or secondary meningeal neoplasia. We describe a rare case of an en plaque tuberculoma accompanied by tuberculous meningitis and tuberculomas.
Abscess ; Korea ; Magnetic Resonance Imaging ; Tuberculoma* ; Tuberculosis ; Tuberculosis, Central Nervous System ; Tuberculosis, Meningeal ; Tuberculosis, Miliary

No abstract available.
Stroke* ; Tuberculoma*

We report a case of a 23-year-old female immigrant from China who was diagnosed with multidrug-resistant tuberculosis affecting her lung and brain, resistant to the standard first-line therapeutics and streptomycin. She was treated with prothionamide, moxifloxacin, cycloserine, and kanamycin. However, her headache and brain lesion worsened. After the brain biopsy, the patient was confirmed with intracranial tuberculoma. Linezolid was added to intensify the treatment regimen, and steroid was added for the possibility of paradoxical response. Kanamycin was discontinued 6 months after initiation of the treatment; she was treated for 18 months with susceptible drugs and completely recovered. To our knowledge, this case is the first multidrug-resistant tuberculosis that disseminated to the brain in Korea.
Biopsy ; Brain* ; China ; Cycloserine ; Emigrants and Immigrants ; Female ; Headache ; Humans ; Kanamycin ; Korea ; Linezolid ; Lung ; Mycobacterium tuberculosis ; Prothionamide ; Streptomycin ; Tuberculoma, Intracranial ; Tuberculosis, Central Nervous System ; Tuberculosis, Multidrug-Resistant* ; Tuberculosis, Pulmonary ; Young Adult

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