A Case of Multiple Brain Tuberculomas in the Subarachnoid Cisterns: Recognition of Radiological Characteristics Regarding the Development of Paradoxical Response during Antituberculosis Treatment

  • SAHARA Kazuma
    Department of Neurosurgery, Tokushima Prefectural Central Hospital
  • SHINNO Kiyohito
    Department of Neurosurgery, Tokushima Prefectural Central Hospital
  • SATO Kenta
    Department of Neurology, Tokushima Prefectural Central Hospital
  • WATARI Yuya
    Department of Neurosurgery, Tokushima Prefectural Central Hospital
  • TAMURA Tetsuya
    Department of Neurosurgery, Tokushima Prefectural Central Hospital
  • KUDO Eiji
    Department of Pathology, Tokushima Prefectural Central Hospital

抄録

<p>Brain tuberculoma and its occurrence within the subarachnoid cisterns is rare in Japan. Serological and cerebrospinal fluid (CSF) examinations and imaging findings lack specificity; thus, preoperative diagnosis is often challenging. This report presents the case of a 70-year-old woman admitted to our hospital with a one-month history of low-grade fever and altered mental status. Based on the CSF analysis and her history of latent tuberculosis infection seven years ago, she was strongly suspected of suffering from tuberculous meningitis (TBM). Consequently, the patient was enrolled in a clinical trial for antituberculosis treatment (ATT). CSF soluble interleukin-2 receptor level decreased from 2,926 U/mL on day 1 to 225 U/mL 42 days after initiating ATT. Her condition improved after five weeks; however, contrast-enhanced T1-weighted magnetic resonance imaging (MRI) revealed multiple enhanced lesions within the basal subarachnoid cisterns 25 days after admission. As the number and size of these lesions increased, a biopsy confirmed brain tuberculoma diagnosis, and the treatment was continued. In conclusion, when intracisternal scattered mass lesions are identified during TBM treatment, we should consider the possibility of tuberculoma developments arising from a paradoxical response (PR) during the treatment. Serial MRIs are crucial in monitoring PR development in cisternal tuberculomas, an extension of severe TBM. Finally, a PR can be effectively managed by continuing ATT with adjunctive corticosteroids.</p>

収録刊行物

  • NMC Case Report Journal

    NMC Case Report Journal 11 (0), 93-98, 2024-12-31

    一般社団法人 日本脳神経外科学会

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