Disseminated tuberculosis in a pregnant woman presenting with numerous brain tuberculomas: case report

Arquivos de Neuro-Psiquiatria

Emerson L. Gasparetto¹  Priscilla Tazoniero¹  Arnolfo De Carvalho Neto¹ 

[1] ,University of Parana School of Medicine Department of Internal Medicine Curitiba PR ,Brazil

关键词: central nervous system;    tuberculosis;    pregnancy;    tuberculoma;    sistema nervoso central;    tuberculose;    gravidez;    tuberculoma;   

DOI  :  10.1590/S0004-282X2003000500028

来源: SciELO

【 摘 要 】

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, which has the pulmonary form as the most common presentation. Dissemination of the disease is common in immunocompromised patients, but immunodeficiency related to pregnancy severe enough to cause dissemination of the Mycobacteria is exceedingly rare. When dissemination occurs, any organ may be affected and in central nervous system, the infection presents as meningitis and single brain parenchyma tuberculomas. We report the case of a 17 year-old woman at the 34th week of pregnancy with respiratory and high intracranial pressure symptoms. On the day before admission she had a sudden onset of paraparesis and urinary retention and ten hours after the delivery she presented with paraplegia . The chest X-ray and CT scan were compatible with miliary tuberculosis. The cranial CT scan revealed numerous rounded hypodense lesions located at cerebral and cerebellar hemispheres, which presented ring-like enhancement after contrast injection. The patient underwent a craniotomy with biopsy of the lesions confirming the diagnosis of brain tuberculomas. The three-drug regimen was started and the cranial CT scan performed a year after diagnosis showed no brain lesions. We emphasize the aggressive dissemination of the disease in this case associated with pregnancy and the importance of early diagnosis and institution of therapy resulting in regression of the lesions.

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