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

We report a rare case of oculomotor nerve palsy and choroidal tuberculous granuloma associated with tuberculous meningoencephalitis. A 15-year-old male visited our hospital for an acute drop of the left eyelid and diplopia. He has been on anti-tuberculous drugs (isoniazid, rifampin) for 1 year for his tuberculous encephalitis. A neurological examination revealed a conscious clear patient with isolated left oculomotor nerve palsy, which manifested as ptosis, and a fundus examination revealed choroidal tuberculoma. Other anti-tuberculous drugs (pyrazinamide, ethambutol) and a steroid (dexamethasone) were added. After 3 months on this medication, ptosis of the left upper eyelid improved and the choroidal tuberculoma decreasedin size, but a right homonymous visual field defect remained. When a patient with tuberculous meningitis presents with abrupt onset oculomotor nerve palsy, rapid re-diagnosis should be undertaken and proper treatment initiated, because the prognosis is critically dependent on the timing of adequate treatment.
Adolescent ; Antitubercular Agents/therapeutic use ; Blepharoptosis/diagnosis/drug therapy/microbiology ; Choroid Diseases/diagnosis/drug therapy/*microbiology ; Dexamethasone/therapeutic use ; Drug Therapy, Combination ; Ethambutol/therapeutic use ; Glucocorticoids/therapeutic use ; Humans ; Magnetic Resonance Imaging ; Male ; Meningoencephalitis/diagnosis/drug therapy/*microbiology ; Mycobacterium tuberculosis/*isolation & purification ; Oculomotor Nerve Diseases/diagnosis/drug therapy/*microbiology ; Perimetry ; Pyrazinamide/therapeutic use ; Radiography, Thoracic ; Tuberculoma/diagnosis/drug therapy/*microbiology ; Tuberculosis, Meningeal/diagnosis/drug therapy/*microbiology ; Tuberculosis, Ocular/diagnosis/drug therapy/microbiology ; Visual Fields

Primary hepatic tuberculoma is a rare malady that is not accompanied by local symptoms, so the diagnosis can frequently be delayed or misconceived as other disease. We report here on an unusual case of primary hepatic tuberculoma that was misconceived as a cholangiocarcinoma on the imaging study. A 54-year-old man presented with dyspepsia and weight loss for 1 month. Abdominal computerized tomography demonstrated a solitary space-occupying lesion on the left lobe of the liver that suggested there was a cholangiocarcinoma accompanied with gastric outlet obstruction. The lesion was diagnosed by the ultrasonographic guided liver biopsy as a chronic granulomatous inflammation with necrosis, and the patient was treated via surgical resection with gastro-jejunostomy followed by antituberculosis chemotherapy. Twelve months later, no evidence of recurrence was noted when examining the patient's symptoms and the imaging studies.
Biopsy ; Cholangiocarcinoma* ; Diagnosis ; Drug Therapy ; Dyspepsia ; Gastric Outlet Obstruction ; Humans ; Inflammation ; Liver ; Middle Aged ; Necrosis ; Recurrence ; Tuberculoma* ; Weight Loss

The diagnosis of incracranial tuberculoma in immune-compromised hosts is often difficult because conventional magnetic resonance (MR) imaging of tuberculoma reveals various findings and neurologic symptoms are not typical. Here, we report a case of a 54-yr old man with multiple intracranial tuberculoma who was treated for acute myeloid leukemia. He complained of right-side paresthesia after the third consolidation chemotherapy without leukemic relapse and fever. MR imaging of the brain showed multiple ring-enhanced lesions in the cerebrum, cerebellar hemisphere, and pons. The lesions appeared to mimic a metastatic tumor or abscess. Cerebrospinal fluid analysis showed no abnormal cells, but the level of adenosine deaminase was elevated (28.8 IU/L, normal 0-8). Stereotactic brain biopsy was performed, but only reactive gliosis was observed. To confirm diagnosis, an open brain biopsy was performed. The histopathology demonstrated chronic granulomatous inflammation with caseous necrosis. Tuberculous-polymerase chain reaction of the biopsy showed a positive result. He was treated with anti-tuberculosis medication and a high dose of steroid. Paresthesia improved, and follow-up brain MR imaging showed the decreased size and numbers of ring-enhanced lesions and improvement of perilesional edema 1 month after treatment. Here, we report on an interesting case of intracranial tuberculoma in acute myeloid leukemia.
Antitubercular Agents/therapeutic use ; Brain Neoplasms/*diagnosis ; Diagnosis, Differential ; Humans ; Leukemia, Myeloid, Acute/*complications ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Sarcoma, Myeloid/*diagnosis ; Tuberculoma, Intracranial/complications/*diagnosis/drug therapy

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

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*

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

We report a 63-years-old woman who developed a nodular lesion in right upper lobe (RUL) of lung after achieving a partial response with salvage chemotherapy for relapsed non-Hodgkin's lymphoma (NHL). Previously, she had been diagnosed as NHL and tuberculous lymphadenitis resulting a complete response with 8 cycles of CHOP regimen and anti-tuberculosis medication for 1 year. CT scan of the chest showed an irregular marginated soft tissue density in RUL with internal punctate calcifications and this lesion was difficult to discriminate between pulmonary tuberculosis and parenchymal involvement of NHL. Because the pulmonary infiltrations progressed despite empirical anti-tuberculosis medication, we performed bronchoscopic biopsy, showing diffuse large B-cell lymphoma. Thereafter, the pulmonary infiltrations were markedly improved with salvage chemotherapy. However, she died of refractory NHL despite high-dose chemotherapy with autologous peripheral blood stem cell transplantation.
Biopsy ; Diagnosis ; Drug Therapy ; Female ; Humans ; Lung ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin* ; Pathology ; Peripheral Blood Stem Cell Transplantation ; Thorax ; Tomography, X-Ray Computed ; Tuberculoma* ; Tuberculosis ; Tuberculosis, Lymph Node ; Tuberculosis, Pulmonary

Central nervous system(CNS) involvement by tuberculosis is uncommon in comparison to the involvement of other systems. Untreated tuberculous meningitis is characterized by progressive stupor and a fatal outcome within 4 to 8 weeks of the onset of symptoms. So rapid detection of Mycobacterium tuberculosis is of vital importance for these patients. In almost all patients with tuberculous meningitis, acid-fast bacteria are undetectable in the CSF. Culture techniques that permit the identification of the isolated mycobacterial species require several weeks. We report a case of tuberculous meningitis with intracranial tuberculoma in 8-year old male who experienced pleural effusion, repeatedly. CSF findings did not reveal diagnosis tuberculous meningitis. In MRI study, multiple intracranial tuberculomas were located at the cerebellum. Prolonged treatment with anti- tuberculous chemotherapy and high-dose corticosteroids led to complete recovery.
Adrenal Cortex Hormones ; Bacteria ; Cerebellum ; Child ; Culture Techniques ; Diagnosis ; Drug Therapy ; Fatal Outcome ; Humans ; Magnetic Resonance Imaging ; Male ; Mycobacterium tuberculosis ; Pleural Effusion* ; Stupor ; Tuberculoma* ; Tuberculoma, Intracranial ; Tuberculosis ; Tuberculosis, Meningeal

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