Central Nervous System Tuberculosis Research Articles

FRI330 A Rare Case Of Hypogonadotropic Hypogonadism In A Patient With Disseminated Tberculosis And Tuberculoma Involving Tuberculum Sellae

Abstract Disclosure: J.S. Genkil: None. S. Ahsun: None. N. Mohan: None. C. Anastasopoulou: None. Introduction: Central nervous system (CNS) tuberculosis accounts for 1-10% of all tuberculosis (TB) infections and has been known to lead to irreversible consequences. CNS TB may present variably as meningeal tuberculosis, tuberculoma, tuberculous abscess, hydrocephalus, ventricular involvement or cerebritis. Tuberculomas involving the sellar region are amongst the rarest of presentations. We describe a unique case of hypogonadotropic hypogonadism with CNS tuberculoma. Case: A 46-year-old male with depression, alcohol use, tobacco smoking, and daily K2 spice use presented to the hospital with multiple days of upper extremity weakness, seizures, and slurred speech. Head CT was done that showed a soft tissue density with mild hypoattenuation on the right frontal region. MRI of the brain showed 3 round 4-5mm lesions with rim enhancement in the frontal lobes. Chest CT showed apical lung lesion. It was believed that patient had a malignant process with metastasis to the brain. During his course, it was discovered that he had TB exposure from his mother several months ago. Despite multiple negative AFB sputum samples, left lung biopsy confirmed TB diagnosis. He was subsequently diagnosed with tubercular meningitis with tuberculomas, one of them involving tuberculum sellae. The patient was started on antitubercular treatment with isoniazid, rifampin, pyrazinamide, streptomycin, and dexamethasone. Lab revealed normal thyroid studies, but very low total testosterone<20 ng/dl (Normal 220-872 ng/dl), with low FSH=2.6 IU/L (Normal 1-12 IU/L) and LH=0.8 IU/ml (Normal 0.6-12.1 IU/ml), with normal prolactin=7.9 ug/L (Normal 3.5-19.4 ug/L). To treat hypogonadotropic hypogonadism, the patient was started on weekly testosterone supplementation with testosterone cypionate 50 mg subcutaneous injections. Ultimately the patient was discharged to a full-time nursing facility and made significant clinical and functional improvement. Discussion: TB of the CNS is among the least common of extra pulmonary tuberculosis yet is associated with the most devastating manifestations making it a feared complication of TB. These lesions are associated with high rates of morbidity and mortality despite appropriate therapy so prompt diagnosis is key. CNS tuberculomas may present isolated or in combination with pulmonary TB. They are unique as they may masquerade as other intracranial space occupying lesions such as tumors or hematomas, further complicating diagnosis. In particular, sellar and suprasellar region tuberculomas are rare and can present with varied amount of hypopituitarism. In the patient’s case, he developed hypogonadotropic hypogonadism which was successfully treated with testosterone replacement. Hypogonadotropic hypogonadism can only be recognized if there is a high index of suspicion and can result in improvement of the quality of life with preservation of sexual function. Presentation: Friday, June 16, 2023

Diagnostic validity of MRI for central nervous system tuberculosis: protocol for a systematic review and meta-analysis

IntroductionCentral nervous system tuberculosis (CNSTB) is a severe condition, sometimes associated with a poor prognosis. Early diagnosis of CNSTB remains challenging, considering that conventional methods lack sensitivity or might lead...

Diagnostic Efficacy of New Xpert Ultra for Extrapulmonary Tuberculosis Using Culture and Composite Reference Standard.

Xpert Ultra (Cepheid, USA) is recently introduced with an extra category of trace-positive results and higher sensitivity for tuberculosis (TB) diagnosis. The objective of the study was to assess the diagnostic accuracy of Xpert Ultra for extrapulmonary samples using culture and composite reference standard (CRS) as the gold standard. In a 1-year (March 2021-22) prospective observational study, samples of suspected extrapulmonary TB (EPTB) patients were subjected to Ziehl-Neelsen staining, culture, and Xpert Ultra (Cepheid, Sunnyvale, CA) tests. Relevant clinical and treatment information was noted. The diagnostic accuracy of Xpert Ultra compared with culture and CRS was calculated. Out of 1720 suspected patients of EPTB, 223 (13%), predominantly males 135 (60%), with a mean age of 41.46 ± 19.81 years, were diagnosed as TB positive following CRS criteria. The maximum cases were of pleural TB (35.4%), followed by central nervous system TB (17.9%), gastrointestinal TB (17.5%), and lymph node TB (12.1%). Of all samples, 150 (8.7%) were microbiologically confirmed, including 141 detected by Xpert ultra, 67 culture positive, and only 16 smear positive. Among the Xpert Ultra-positive samples, 35 showed trace results, including six false-positive results. Considering culture and CRS as the gold standard, the sensitivity (86.57%, 59.64%) and specificity (94.98%, 99.47%) of Xpert Ultra were calculated, respectively. Rifampicin resistance was detected in 1 (0.70%) sample. Diagnosis of EPTB is a challenge and Xpert Ultra may detect TB at a very early stage. However, it is essential to rule out false-positive results. Additional studies are needed on Xpert Ultra to interpret trace results better.

A-257 Association Between Matrix Metalloproteinase-3 and its Post-Transcriptional Regulator miR-17-5p in the Pathogenesis of Tuberculous Meningitis Patients

Abstract Background Tuberculosis, a communicable disease caused by Mycobacterium tuberculosis is one of the top 10 causes of death worldwide. Tuberculous meningitis (TBM), an extra-pulmonary central nervous system tuberculosis is the most severe form with maximum mortality. To combat the complications of disease, host immune response gets activated which initially protects the host but later an exaggerated response leads to aggravation of the disease. This causes tremendous neuroinflammation which further increases the complications of the disease. Matrix metalloproteinase (MMPs) like MMP-9, 2 and 3 are known to cause damage to the blood brain barrier and have a role in the pathogenesis of disease particularly increasing the neuroinflammation. MMPs are regulated at post-transcriptional level by microRNAs (miRNA) that alter their levels by targeting various genes. Based on available literature we found miR-17-5p to be a key regulator of MMP3. In this study, we assessed the levels of MMP3 and its post-transcriptional regulator miR-17-5p in the cerebrospinal fluid (CSF) of TBM patients, healthy controls (HC) and non-infectious neuroinflammatory disease patients (NID). Methods In this study, 100 TBM patients were recruited based on the Lancet scoring system and CSF samples were collected. For NID control group, 25 patients with other non-infectious neuroinflammatory diseases like Guillain-Barre syndrome, multiple sclerosis were recruited. Twenty five HC CSF samples were collected from patients undergoing spinal anaesthesia for any lower limb surgery. The samples were stored at −80°C and processed when required for ELISA and quantitative real time PCR. Results We found a significant increase in levels of median MMP3 levels in the CSF of TBM patients compared to HC group (2.719 ng/ml vs 1.696 ng/ml). The MMP3 levels were also significantly elevated in the NID control group as compared to HC group (3.116 ng/ml vs 1.696 ng/ml). A stagewise comparison in TBM group showed an increase in levels of MMP3 with respect to HC but within stages results were comparable. The expression of MMP3 regulator miR-17-5p showed an upregulation in the CSF of TBM group as compared to NID and HC group. Conclusion An increase in levels of MMP3 was observed in both TBM and NID group which infers that MMP3 might have a role in neuroinflammation in neurological conditions. In our study groups we did not find any relation between miR-17-5p expression and MMP3 levels, indicating that there might be some other regulatory pathway altering the levels of MMP3 in neurological conditions. Hence, further studies can be done to highlight the explicit role of MMP3 in neuroinflammation which can then be targeted therapeutically to relieve the associated complications.

Predicting the Risk of Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome in HIV-Infected Patients with Central Nervous System Tuberculosis

Objective — to identify risk factors associated with the development of Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome (TB-IRIS) in HIV-infected patients with central nervous system tuberculosis. The analysis assessed the relationship between the risk of develo­ping TB-IRIS with neurological manifestations and the following factors: 1) viral load before antiretroviral therapy (ART) initiation; 2) CD4+ lymphocyte of blood before ART initiation; 3) duration of antituberculosis therapy before starting ART; 4) presence of active tuberculosis at the time of ART initiation. Materials and methods. 112 cases of neurological TB-IRIS were analyzed. These patients were treated and observed during the 1 year in anti-tuberculosis facilities in Kyiv and Kyiv region in 2017—2021. All patients received ART in accordance with the HIV treatment protocols adopted in Ukraine. Treatment according to the standard of tuberculosis treatment adopted in Ukraine. The logistic regression model construction method was used to analyze. Statistical processing of the obtained data was carried out using free software — the EZR package (version 1.61; https://www.jichi.ac.jp/).The study was carried out as part of the applied research work 0121U107800 «Predicting the development of the incidence of tuberculosis in Ukraine in connection with the COVID-19 pandemic», funded by the Ministry of Health of Ukraine. Results and discussion. After calculations, two factor signs were identified, associated with the of deve­loping TB-IRIS with neurological manifestations: the baseline level of CD4+ lymphocytes in 1 μl of blood at the beginning of treatment and the presence of active tuberculosis at the time of ART initiation. Conclusions. It was found that the risk of developing TB-IRIS with neurological manifestations is significantly associated (p < 0.05) with the following factors: 1) the level of CD4+ lymphocytes in 1 μl at the beginning of treatment; 2) presence of active tuberculosis at the time of ART initiation.

Deaths from tuberculosis: differences between tuberculosis-related and non-tuberculosis-related deaths.

Tuberculosis (TB) is a major cause of ill health and one of the leading causes of death worldwide. The first step in developing strategies to reduce TB mortality is to identify the direct causes of death in patients with TB and the risk factors for each cause. Data on patients with TB systemically collected from the National Surveillance System of South Korea from January 2019 to December 2020 were included in this study. We analyzed the clinical characteristics associated with TB and non-TB-related deaths, including TB-related symptoms, comorbidities, and radiographic and microbiological findings. Of the total of 12,340 patients with TB, 61% were males with a mean age of 61.3 years. During the follow-up period, the overall mortality rate was 10.6%, with TB-related deaths accounting for 21.3% of all TB deaths. The median survival time in the TB-related death group was 22 days. TB-related death was associated with older age, lower body mass index (BMI), dyspnea, fever, general weakness, bilateral radiographic patterns, and acid-fast bacilli (AFB)-positive smears. Non-TB-related deaths were associated with older age, male sex, lower BMI, comorbidities of heart, liver, kidney, and central nervous system (CNS) diseases, CNS TB involvement, the presence of dyspnea, general weakness, and bilateral radiographic patterns. Patients with high-risk TB must be identified through cause-specific mortality analysis, and the mortality rate must be reduced through intensive monitoring of patients with a high TB burden and comorbidities.

Recent advances in microbiological and molecular biological detection techniques of tuberculous meningitis.

Tuberculous meningitis (TBM) is the most common type of central nervous system tuberculosis (TB) and has the highest mortality and disability rate. Early diagnosis is key to improving the prognosis and survival rate of patients. However, laboratory diagnosis of TBM is often difficult due to its paucibacillary nature and sub optimal sensitivity of conventional microbiology and molecular tools which often fails to detect the pathogen. The gold standard for TBM diagnosis is the presence of MTB in the CSF. The recognised methods for the identification of MTB are acid-fast bacilli (AFB) detected under CSF smear microscopy, MTB cultured in CSF, and MTB detected by polymerase chain reaction (PCR). Currently, many studies consider that all diagnostic techniques for TBM are not perfect, and no single technique is considered simple, fast, cheap, and efficient. A definite diagnosis of TBM is still difficult in current clinical practice. In this review, we summarise the current state of microbiological and molecular biological diagnostics for TBM, the latest advances in research, and discuss the advantages of these techniques, as well as the issues and challenges faced in terms of diagnostic effectiveness, laboratory infrastructure, testing costs, and clinical expertise, for clinicians to select appropriate testing methods.

Tuberculosis-immune reconstitution inflammatory syndrome in an immunocompetent patient

Tuberculosis-immune reconstitution inflammatory syndrome is commonly seen among patients with acquired immunodeficiency syndrome either as a paradoxical worsening of an already diagnosed disease or as an uncovering of a dormant infection. There is evidence of paradoxical worsening of central nervous system tuberculosis (CNS-TB) once the treatment is instituted even among immunocompetent patients leading to significant morbidity. We report a case of a previously well young woman with paradoxical worsening of CNS-TB after commencement of treatment. This case highlights an important possible clinical sequelae of CNS-TB, a practicing physician should be aware of.

Distinguishing clinical characteristics of central nervous system tuberculosis in immunodeficient and non-immunodeficient individuals: a 12-year retrospective study

BackgroundCentral nervous system tuberculosis (CNS TB) is a severe Mycobacterium tuberculosis (MTB) infection. It is unclear whether a patient’s immune status alters the clinical manifestations and treatment outcomes of CNS TB.MethodsBetween January 2007–December 2018, chart reviews of CNS TB, including tuberculous meningitis (TBM), tuberculoma/abscess, and TB myelitis, were made. Subjects were categorized as immunodeficient (ID) and non-immunodeficient (NID).ResultsOf 310 subjects, 160 (51.6%) were in the ID group—132 (42.6%) had HIV and 28 (9.0%) had another ID, and 150 (48.4%) were in the NID group. The mean age was 43.64 ± 16.76 years, and 188 (60.6%) were male. There were 285 (91.9%) TBM, 16 (5.2%) tuberculoma/abscess, and 9 (2.9%) myelitis cases. The TBM characteristics in the ID group were younger age (p = 0.003), deep subcortical location of tuberculoma (p = 0.030), lower hemoglobin level (p < 0.001), and lower peripheral white blood cell count (p < 0.001). Only HIV individuals with TBM had an infection by multidrug-resistant MTB (p = 0.013). TBM mortality was varied by immune status —HIV 22.8%, other ID 29.6%, and NID 14.8% (p < 0.001). Factors significantly associated with unfavorable outcomes in TBM also differed between the HIV and NID groups.ConclusionsTBM is the most significant proportion of CNS TB. Some of the clinical characteristics of TBM, such as age, radiographic findings, hematological derangement, and mortality, including factors associated with unfavorable outcomes, differed between ID and non-ID patients.

Effectiveness of Adjunctive High-Dose Infliximab Therapy to Improve Disability-Free Survival Among Patients With Severe Central Nervous System Tuberculosis: A Matched Retrospective Cohort Study.

Few treatment options exist for patients with severe central nervous system (CNS) tuberculosis (TB) worsening due to inflammatory lesions, despite optimal antitubercular therapy (ATT) and steroids. Data regarding the efficacy and safety of infliximab in these patients are sparse. We performed a matched retrospective cohort study based on Medical Research Council (MRC) grading system and modified Rankin Scale (mRS) scores comparing 2 groups of adults with CNS TB. Cohort A received at least 1 dose of infliximab after optimal ATT and steroids between March 2019 and July 2022. Cohort B received only ATT and steroids. Disability-free survival (mRS score ≤2) at 6 months was the primary outcome. Baseline MRC grades and mRS scores were similar between the cohorts. Median duration before initiation of infliximab therapy from start of ATT and steroids was 6 (IQR: 3.7-13) months and for neurological deficits was 4 (IQR: 2-6.2) months. Indications for infliximab were symptomatic tuberculomas (20/30; 66.7%), spinal cord involvement with paraparesis (8/30; 26.7%), and optochiasmatic arachnoiditis (3/30; 10%), worsening despite adequate ATT and steroids. Severe disability (5/30 [16.7%] and 21/60 [35%]) and all-cause mortality (2/30 [6.7%] and 13/60 [21.7%]) at 6 months were lower in cohort A versus cohort B, respectively. In the combined study population, only exposure to infliximab was positively associated (aRR: 6.2; 95% CI: 2.18-17.83; P = .001) with disability-free survival at 6 months. There were no clear infliximab-related side effects noted. Infliximab may be an effective and safe adjunctive strategy among severely disabled patients with CNS TB not improving despite optimal ATT and steroids. Adequately powered phase 3 clinical trials are required to confirm these early findings.

Concentration of contezolid in cerebrospinal fluid and serum in a patient with tuberculous meningoencephalitis: A case report

Central nervous system (CNS) tuberculosis (TB) is a devastating and often life-threatening disease caused by M. tuberculosis. Contezolid, a new oxazolidinone, has demonstrated potent antimycobacterial activity in both in vivo and in vitro studies, with lower toxicity than linezolid. However, the pharmacokinetic datav are still not available for contezolid in the CNS of patients with CNS TB. We report the steady-state concentrations in serum and CSF of a patient receiving contezolid as part of multi-drug treatment for tuberculous meningoencephalitis. At weeks 7 and 11 (7 hours post-dose) after initiation of contezolid therapy, the serum concentration of contezolid was 9.64mg/L and 9.36mg/L, respectively. In CSF, the observed concentration of contezolid was 0.54mg/L and 1.15mg/L. The CSF to serum concentration ratio was 0.056 and 0.123 at week 7 and week 11, respectively. The observed concentrations in CSF were above the minimum inhibitory concentration (MIC) of contezolid against M. tuberculosis and were close to the estimated serum unbound fraction of contezolid (10%), suggesting that the unbound contezolid penetrates well into CSF.

TUBERCULOUS MENINGOENCEPHALITIS COMPLICATED BY TUBERCULOUS ABSCESSES IN AN IMMUNOCOMPETENT INFANT: A CASE REPORT

Central nervous system tuberculosis is a major cause of morbidity and mortality in developing countries. Intracranial tuberculoma is rare and is one of the most serious cases of tuberculosis. We report a case of tuberculous meningoencephalitis complicated by tuberculous abscesses, in a 10-month-old boy with angina and otorrhea 42 days ago. A CT scan of the brain and Rochers TDM showed aggressive bilateral otomastoiditis, more marked on the left, multiple left supratentorial brain formations with subfactorial and temporal involvement in relation to abscesses. Mycobacterium tuberculosis was isolated in the CSF fluid and in the brain pus after surgical drainage. Good clinical and radiological improvement was observed after surgery and treatment with corticosteroids and antituberculosis drugs.

A Rare Case of Meningoencephalo-Myelitis with a Tubercular Origin

Tuberculosis (TB) can affect any bodily system including the central nervous system (CNS). CNS involvement in Tb is fairly uncommon with poor prognosis due to its high mortality and morbidity. Though meningoencephalitis is a frequent presentation of TB, myelitis along with it is rare. Due to the lack of detailed information about meningoencephalo-myelitis, the risk factors and prognosis of these patients are not fully understood. We report such a rare instance of tuberculosis involving the brain, meninges and spinal cord. The patient was a 13-year-old female with the complaints of fever, both lower limb weakness and urinary retention. The diagnosis was made based on the patient’s medical history and physical examination which showed meningeal syndrome, spinal cord and cranial nerve involvement. The diagnosis was confirmed by the analysis of cerebrospinal fluid, magnetic resonance imaging of the brain and spinal cord, and biochemical evidence of tuberculous infection. The patient had a marked clinical improvement and complete neurologic recovery after anti-tubercular treatment and high doses of systemic corticosteroids. The purpose of presenting the case is to share the bizarre presentation of CNS tuberculosis, a diagnostic and therapeutic emergency. Early diagnosis and immediate management may help with the unfavorable prognosis and our report hopes to shed light on it. J Medicine 2023; Vol. 34, No. 2(1) Supplement: 225

Tuberculosis revisted: classic imaging findings in childhood

Tuberculosis (TB) remains one of the major public health threats worldwide, despite improved diagnostic and therapeutic methods. Tuberculosis is one of the main causes of infectious disease in the chest and is associated with substantial morbidity and mortality in paediatric populations, particularly in low- and middle-income countries. Due to the difficulty in obtaining microbiological confirmation of pulmonary TB in children, diagnosis often relies on a combination of clinical and radiological findings. The early diagnosis of central nervous system TB is challenging with presumptive diagnosis heavily reliant on imaging. Brain infection can present as a diffuse exudative basal leptomeningitis or as localised disease (tuberculoma, abscess, cerebritis). Spinal TB may present as radiculomyelitis, spinal tuberculoma or abscess or epidural phlegmon. Musculoskeletal manifestation accounts for 10% of extrapulmonary presentations but is easily overlooked with its insidious clinical course and non-specific imaging findings. Common musculoskeletal manifestations of TB include spondylitis, arthritis and osteomyelitis, while tenosynovitis and bursitis are less common. Abdominal TB presents with a triad of pain, fever and weight loss. Abdominal TB may occur in various forms, as tuberculous lymphadenopathy or peritoneal, gastrointestinal or visceral TB. Chest radiographs should be performed, as approximately 15% to 25% of children with abdominal TB have concomitant pulmonary infection. Urogenital TB is rare in children. This article will review the classic radiological findings in childhood TB in each of the major systems in order of clinical prevalence, namely chest, central nervous system, spine, musculoskeletal, abdomen and genitourinary system.Graphical

The Spectrum of Presentation, Diagnosis, and Clinical Outcome of Central Nervous System Tuberculosis: A Case Series in Bangabandhu Sheikh Mujib Medical University

Bangladesh has the highest prevalence of tuberculosis (TB). Of these, tubercular meningitis is the most common and most devastating. The usual course is that of insidious onset and subacute progression. Adults with TBM often present with the classic meningitis symptoms of fever, headache, and meningismus (stiff neck) along with focal neurological deficits, behavioral changes, and alterations in consciousness. TBM is prone to rapid deterioration once meningeal symptoms and focal neurological signs supervene, leading to stupor, coma, and death within 5 to 8 weeks [1,2].

Clinical Profile of Pediatric Tuberculosis in a Tertiary Hospital in Northeast India: A Retrospective Analysis.

Context Tuberculosis (TB) is India's major public health problem. The profile of childhood TB in the northeast region of India is still limited. Aim To analyze the clinical, radiological, and bacteriological profiles of children with TB at a tertiary health care facility. Materials and methods A three years retrospective descriptive analysis of children admitted to a tertiary centre with TBbefore the introduction of cartridge-based nucleic acid amplification test (CBNAAT) for testing.Children below 18 years who were admitted from 2012 to 2014 and were diagnosed with TB were included. Relevant data were extracted in a predesigned format and entered into a Microsoft Excel sheet. Descriptive statistic was used for analysis. The results of variables are given in proportions and means and a Chi-square test was done for the test of significance using Epi-info tools. The study was done after getting ethical approval from the institute. Results A total of 150 children were included in the analysis with a Male: Female ratio of 1.1:1. A majority of the cases were under five years (n=46) and 11 to 15 years old (n=45) with a mean age of 9.3 ± 4.4 years. Fever was a common presentation (70%). Disseminated TBwas seen in 31.3%, isolated central nervous system (CNS) TB was found in 30.6%, and all CNS TB with dissemination was found in 46 cases (40.7%) making extra-pulmonary TB a common finding in our study (83.3%). Isolated pulmonary TB was seen in 16.7% and total pulmonary cases along with dissemination was seen in 60 cases (40%). A bacteriological diagnosis was made in 23%. Overall mortality was 9.3%, out of which mortality in CNS TB was 13% with a p-value of 0.004 as compared to mortality other than CNS TB which was significant and mortality in under-five years was significant with a p-value of 0.001. Conclusions Pulmonary and extra-pulmonary were both causes of admission in the pediatric age group. We found thatextra-pulmonary TB was the most common cause of admission in children, with CNS manifestation and disseminated TB, being the most common presentations and significant mortality was seen in under-five years and in children diagnosed with CNS TB.

Intracranial Aneurysm In a Case of Tubercular Meningoencephalitis, a Rare Presentation (P3-10.001)

<h3>Objective:</h3> NA <h3>Background:</h3> In this era of advanced medical science and technology, tuberculosis remains as a major health problem in developing countries like India. While pulmonary TB is the most common manifestation of TB, incidence of extrapulmonary TB is also gradually increasing. Affliction of central nervous system is considered one of the most severe forms of extrapulmonary tuberculosis. Central nervous system (CNS) tuberculosis(TB) comprises 15%–20% of the total cases of extra-pulmonary TB and it is associated with a high mortality rate. Surprisingly a little less than 5% of patients with pulmonary TB develop CNS TB and not all patients with CNS TB have pulmonary TB. Although CNS involvement by tuberculosis is seen in all age groups, there is a predilection for younger and immunocompromised patients. Central nervous system tuberculosis may present as tubercular meningitis, meningoencephalitis, tuberculoma, tubercular abscess. Vasculitis, secondary to TBM can cause infarcts commonly but development of an intracranial tuberculous aneurysm is a rare complication. <h3>Design/Methods:</h3> NA <h3>Results:</h3> <h3>Case Report:</h3> A 33-year-old male presented with a low grade fever, meningism for weeks, diagnosed to have tubercular meningoencephalitis after supportive brain imaging and CSF assay. During course of hospitalization developed left ptosis, binocular horizontal diplopia, dimness of vision of left eye with diminished left periorbital sensation suggestive of a left anterior cavernous sinus syndrome. Brain imaging with angiogram of cerebral vasculature revealed an aneurysm at left ICA-MCA junction, probably a sequalae of granulomatous vasculitis <h3>Conclusions:</h3> <h3>Discussion:</h3> This case report shows an unusual case of intracranial tuberculomas complicated by intralesional haemorrhage due to an infective tubercular aneurysm. During disease course, MTB may colonize the arterial wall and erode its entire thickness with caseating necrosis, forming an aneurysm. These aneurysms are prone to rupture with fatal complications. Early identification of the disease with proper treatment is critical for the prevention of fatal complications. <b>Disclosure:</b> Dr. Biswas has nothing to disclose. Dr. Das has nothing to disclose. Dr. Chintha has nothing to disclose. Dr. Bhattacharya has nothing to disclose. Dr. Biswas has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for INTAS Pharmaceuticals. Dr. Biswas has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for lupin Limited. Dr. Biswas has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Diagnostic. Dr. Biswas has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Health N U. Dr. Chakraborty has nothing to disclose.

Clinical Factors Associated with Poor Outcomes in Patients with Central Nervous System Tuberculosis Treated in San Francisco, CA from 2011 to 2021 (S25.006)

<h3>Objective:</h3> To identify risk factors associated with mortality and poor functional outcomes in patients with central nervous system tuberculosis (CNS TB) cared for in San Francisco, CA. <h3>Background:</h3> CNS TB is one of the most severe forms of TB. Studies evaluating risk factors for mortality and disability due to CNS TB are lacking across low- and high-resource settings. <h3>Design/Methods:</h3> Search terms were used to identify medical records from patients with possible CNS TB at two medical centers in San Francisco, CA between January 1st, 2011, and November 1st, 2021. Data was extracted from a sample (n=75) of cases who met criteria for definite or suspected CNS TB warranting treatment with anti-tuberculous medications. Logistic regression models were performed to identify associations of demographic factors, comorbidities, and clinical signs/symptoms with mortality and functional outcomes. <h3>Results:</h3> Of 75 cases of CNS TB, most were men (60%), 18–64 years of age (67%), foreign-born (75%), and publicly insured (60%). Diabetes (28%) and hypertension (45%) were common comorbidities. The prevalence of HIV (9.8%) was 32 times higher than in the general California population. Many patients experienced long-term moderate to severe impairments in mobility (56%) and cognition (47%) and loss of independent function (50%). Increasing age (OR=1.04 per year, 95%CI:1.00–1.07), hypertension (OR=5.40, 95%CI:1.24–23.10), intubation (OR=9.14, 95%CI: 2.14–39.07), and altered mental status (OR=7.09, 95%CI: 1.61–31.30) were significantly associated with increased odds of mortality. Altered mental status at presentation (p&lt;0.001) and hydrocephalus (p=0.040) were associated with a greater likelihood of long-term cognitive impairment. <h3>Conclusions:</h3> Mortality and functional impairment were common in patients with CNS TB cared for over the past decade in San Francisco. Older patients and those with hypertension had worse outcomes, as did patients presenting with altered mental status and hydrocephalus. Earlier CNS TB diagnosis and more effective treatment, including for patients with select risk factors, are needed to improve outcomes. <b>Disclosure:</b> Mr. HERNANDEZ CASTILLO has nothing to disclose. Dr. Chow has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Medicolegal consulting. The institution of Dr. Chow has received research support from NIH. Dr. Louie has nothing to disclose. Ms. Romo has nothing to disclose.

Giant Intracranial Tuberculoma Resembling a Brain Tumor: A Diagnostic Challenge

Despite being potentially remediable, central nervous system tuberculosis continues to be a major cause of morbidity and mortality in developing countries. Intracranial tuberculoma is one of the many presentations of CNS tuberculosis that can occur as solitary or multiple lesions. When tuberculomas are solitary and extremely large, they may cause increased intracranial pressure, compressive focal neurological deficits, or epileptic seizures mimicking a malignant lesion. Even using magnetic resonance imaging and spectrography, giant tuberculoma and brain tumors could be mistaken for one another, which warrants consideration of an infectious etiology as a diagnostic differential for prompt diagnosis and appropriate treatment plan. This case study demonstrates a 22-year-old woman who presented with headache, nausea and vomiting ,blurring of vision , weakness of the right side of the body, and features of frontal lobe syndrome with no particular clinical features of TB, and underwent craniotomy who had a preoperative diagnosis of brain tumor. Histopathology later revealed it to be a tuberculoma. J Shaheed Suhrawardy Med Coll 2021; 13(2): 177-182

Cognitive impairment in patients with central nervous system tuberculosis.

Tuberculosis (TB) in Mexico remains an important cause of morbidity and mortality; in the past 4 years, 110,681 cases of pulmonary tuberculosis and 1571 cases of tuberculous meningitis were reported. To determine the neurocognitive sequelae, clinical presentation and neuroimaging alterations in patients with central nervous system tuberculosis. A retrospective, analytical, and cross-sectional study was carried out from 2010 to 2019. Patients with central nervous system tuberculosis, with and without HIV/AIDS coinfection, were included. During the study period, 104 cases with a definitive or probable central nervous system tuberculosis diagnosis were included; 38% had HIV/AIDS coinfection, and 55%, various comorbidities (p = 0.0001); 49% had cognitive alterations, and 14% died. Although HIV/AIDS infection can contribute to cognitive decline in patients with tuberculous meningitis, no differences were observed between patients with and without HIV/AIDS. Cognitive sequelae showed improvement during follow-up with adequate management and therapeutic control of the patients.