A Rare Presentation of Invasive Tuberculosis of the Central Nervous System in an Immunocompetent Patient in a Nonendemic Country.

Rita Martins,Jose Campillo,Ana Valverde,Carlos Casimiro

doi:10.1155/2018/2940947

Abstract

We herein report a rare case of a 25-year-old immunocompetent male patient with disseminated tuberculosis of central nervous system (CNS), first presenting as multiple cerebral lesions with no meningeal involvement. Subsequent diagnostic workup disclosed extensive peritoneal involvement. A broad differential diagnosis was considered, including neoplastic and infectious diseases. The diagnosis was confirmed with positive PCR result for Mycobacterium tuberculosis in the biopsied mesenteric tissue. The patient was started on tuberculostatic regimen with favorable outcome. No acquired or hereditary immunodeficiency was documented. Disseminated tuberculosis in immunocompetent individuals is extremely rare. Genetic susceptibility factors have been reported in individuals with extensive forms of the disease and a high index of suspicion is required, as observed in our case.

Highlights

central nervous system (CNS) tuberculosis represents only 5% of extrapulmonary disease manifestations
In nonendemic countries, disseminated tuberculosis is mainly observed in adult immigrants from high prevalence areas and immunocompromised patients [3, 4]
Recent studies have suggested a genetic defect in the interleukin-12 (IL-12) and interferon-gamma pathways as predisposing factors for this disease form

Summary

Introduction

CNS tuberculosis represents only 5% of extrapulmonary disease manifestations. Neurotuberculosis without pulmonary involvement is extremely rare and disseminated forms in immunocompetent patients are very infrequent [1, 2].

Case Presentation

Findings

Discussion