Multiple Tuberculomas Research Articles

Parameters of the mmp / timp system in assessing the clinical course of pulmonary tuberculoma

Aim. To study the parameters of the matrix metalloproteinase (MMP) / tissue inhibitors of metalloproteinase (TIMP) system in assessing the clinical course of pulmonary tuberculoma.Materials and methods. We examined 87 patients (55 men and 32 women), average age 33 [28; 43] years, with a morphologically and bacteriologically confirmed diagnosis of tuberculoma, who received treatment at St. Petersburg Research Institute of Phthisiopulmonology. In all patients, computed tomography of the chest, fiberoptic bronchoscopy, and lung function tests were performed. In the blood serum, concentrations of MMP-1, -8, -9, and their tissue inhibitor TIMP-1 were determined using ELISA (R&D Systems, USA), and the activity of α2-macroglobulin (MG) was determined by the enzyme assays. For statistical data processing, Statistica 10.0 and R were used.Results. In the study group, single and multiple tuberculomas were revealed in 37 and 63% of cases, respectively, necrotic areas – in 50% of patients, external respiration disorders – in 48% of cases, and catarrhal bronchitis (CB) – in 77% of cases. Tobacco smokers (TS) were identified in 69% of cases. Significant differences between MMP concentrations allowed us to distinguish four patterns from the characteristics adopted for the clinical and radiological assessment of disease intensity. It was shown that an increase in the levels of MMP-1 and MMP-9 can be a predictor of tuberculoma progression caused by a diffuse process with necrotic areas and bronchogenic dissemination (pattern 1, 2). Changes in the levels of MMP-8, TIMP-1 or MG (pattern 3, 4) were associated with permanent exposure to a non-specific component of inflammation (TS or CB).Conclusion. Changes in the MMP / TIMP system parameters can be used as objective laboratory protein biomarkers to assess the clinical course of pulmonary tuberculoma.

Computer Tomography (CT)-Based Study to Investigate Feasibility and Efficacy of Thoracoscopic Surgery in the Treatment of Penetrating Chest Wall Tuberculosis.

Chest wall tuberculosis may develop if tuberculous (TB) lesions spread through the chest wall and invade the thoracic cavity. The presence of a mass on the patient's chest wall may be the first indication of TB, and a chest CT scan can help diagnose external penetrating chest wall TB, the incursion of tuberculosis from the lungs into the chest wall. This study examines the safety and efficacy of thoracoscopic-assisted surgery for the treatment of penetrating chest wall tuberculosis as a means of exploring novel concepts of minimally invasive surgery. Our hospital conducted a retrospective study of 25 patients with penetrating chest wall TB who underwent thoracoscopic surgery between January 2020 and June 2021. General demographics, CT scan data linked to surgery, and postoperative patient outcomes were compared between the two groups. The data was also evaluated to determine the range of operation time and the volume of bleeding from different foci in the thoracic cavity. All procedures went well after patients took conventional antituberculosis medication for at least two weeks prior to surgery. CT scans showed that thoracoscopic surgery needed a smaller incision than traditional chest wall TB surgery, with no discernible increase in surgical time. Postoperative tube use, length of hospital stay, and blood loss were all significantly lower than they would have been with conventional surgery. In addition, thoracoscopy was associated with a significantly reduced rate of subsequent treatment. Fibrous plate development and calcification caused the longest operation times in the thoracoscopic surgery group, whereas multiple pleural tuberculomas generated the most hemorrhage. Thoracoscopic surgery usually reveals tuberculous foci hiding in the thoracic cavity. Thethoracic surgery can eliminate the TB focus in the chest wall and intrathoracic while treating penetrating chest wall tuberculosis. The CT scan is a crucial part of the diagnostic process for these patients. Minor surgical trauma, low complication and recurrence rates, and good results. There is a greater distinction between the two surgical approaches for patients with penetrating chest wall TB as opposed to those with basic chest wall tuberculosis.

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Tuberculosis (TB) remains a global medical problem and is one of the leading causes of death from infectious diseases worldwide. One of the main factors preventing successful control of the infection is the progressive increase in cases of drug-resistant TB. In order to increase the effectiveness of treatment of patients with resistant forms of TB, more and more attention is paid to a complex approach in the treatment of such patients, using surgical methods of treatment. The aim of the work is to determine and compare the clinical and pathological characteristics of pulmonary tuberculosis with different grade of drug resistance to antituberculosis drugs and additional surgical treatment. Materials and methods. This was a cohort retrospective study, which enrolled 49 patients with different clinical forms of pulmonary TB and defined antituberculosis drug resistance profile (MDR-TB or pre-XDR-TB groups according to the the results of drug susceptibility test). The 1-st group included MDR-TB cases (n=25) and the 2-nd group � pre-XDR-TB cases (n=24). The 1-st group consisted of 15 men and 10 women, 2nd group � 10men and 14 women, respectively. The mean age of patients in both groups was approximately the same: 32.2�2.3 years in grouo 1, and 30.6�1.8 years in group 2. Surgery was performed after completion of a standardized 6-month or individualized chemotherapy. Clinical-morphological forms of pulmonary TB were determined based on a comprehensive analysis of the results of chest X-ray, macroscopic examination of the operative material and histological examination of the affected tissue. Morphological signs determined the activity of a specific inflammatory process during histological examination. Results. The clinical-morphological forms of pulmonary TB were established in both groups based on radiological and pathomorphological examination data and a comparative analysis between the groups was carried out. Fibro-caseous TB was diagnosed almost three times more often in the group with pre-XDR-TB by chest X-ray examination. Single or multiple tuberculomas, on the contrary, were 2 times more common in the MDR-TB group. Regardless of the resistance profile, the most common surgical intervention was a resection of a segment or several segments of the lung (77.5 % of cases). The forms of pulmonary tuberculosis established by means of radiological and morphological examination were compared. In MDR-TB group, complete coincidence of diagnosis occurred in 19 out of 25 cases (76.0 %). In pre-XDR-TB group, complete agreement of radiological and morphological diagnosis observed in 11 out of 24 cases (45.8 %). Moreover, the diagnosis of tuberculoma in both groups most often coincided. In cases with pre-XDR-TB, tuberculosis mycobacteria were detected by the cultural method in the operative material almost 2 times more often. In both groups, morphological signs of high or moderate activity of specific inflammation were observed in 70�80 % of cases. Conclusions. In cases of MDR-TB, progression of specific inflammation persisted in 32 %, and in cases of pre-XDR-TB � in 21 %, respectively. Stabilization of the process before surgical treatment was established in almost half of the cases of both MDR-TB (48.0 %) and pre-XDR-TB (50.0 %) groups. Only in 20-29 % of cases was the regression of a specific process was registared. Regardless of the drug-resistant profile, different forms of pulmonary TB were presented in both study groups. Thus, just a complex of clinical and morphological examinations makes can objectively determine the form of pulmonary tuberculosis and the grade of morphological activity of specific inflammation at the time of surgical intervention. Key words: drug-resistant pulmonary tuberculosis, clinical-morphological forms, surgical treatment, histological examination.

Miliary tuberculosis mimicking COVID-19 multisystemic inflammatory syndrome in children

Miliary tuberculosis (TB) is a severe form of disseminated TB. In pediatrics, many cases are missed because the symptomatology of TB mimics common childhood diseases.We present the case of a 6-year-old girl with no remarkable history who had recurrent fever for 3 months. She was initially diagnosed with, and treated for, refractory multisystem inflammatory syndrome in children (MIS-C). When the study was extended to other differential diagnoses, thoraco-abdominopelvic computed tomography revealed miliary pulmonary nodules in addition to lymph nodes and spleen lesions. Magnetic resonance imaging of the brain revealed multiple tuberculomas. The tuberculin test results were positive. The course of the disease was favorable under quadruple therapy.

Isolated 3rd Nerve Palsy Presenting in a Background of Multiple Cerebellar Tuberculoma with Tubercular Meningitis

Isolated 3rd Nerve Palsy Presenting in a Background of Multiple Cerebellar Tuberculoma with Tubercular Meningitis

ЭФФЕКТИВНОСТЬ ЛЕЧЕНИЯ ЛЕГОЧНЫХ ГРЫЖ С ИСПОЛЬЗОВАНИЕМ СЕТЧАТОГО ИМПЛАНТА У БОЛЬНЫХ, ПЕРЕНЕСШИХ ПНЕВМОНЭКТОМИЮ ПО ПОВОДУ ТУБЕРКУЛЕЗА

Objective: to assess effectiveness of surgical treatment for mediastinal lung hernias using a polymeric mesh implant in patients after pneumonectomy due to TB. Materials and methods. Polymeric mesh implants were installed to 15 patients, which developed mediastinal lung hernias after pneumonectomy due to TB. Four of these patients underwent lung hernia plasty along with resection of the only lung, where single or multiple tuberculomas were detected. The assessment of treatment effectiveness was based on the features of early and late (after 3 months) postoperative period, dyspnea severity by the mMRC scale, radiological and spirometric data, and blood gases. The resection samples were studied morphologically to determine activity of TB process in the only lung. Results. The effectiveness of treatment for mediastinal lung hernias was 93%. Technical success was achieved in 100% of patients. The complications in the postoperative period were lessthan 7% (one case). Dyspnea decreased by 46% by the mMRC scale. The medians of FVC and FEV1 decreased by 12.8% and 11.6% respectively, the median of PaO2 increased by 6 mm Hg (9% of the baseline value). The median of the shifted lung tissue volume (V cm3) decreased by 57%. Active TB process was observed in the resection samples of the single lung. Conclusion. Anterior mediastinal plasty using a polymeric mesh implant is a safe and highly effective method of treatment for mediastinal lung hernias. Timely use of this method postpneumonectomy patients is necessary to obtain positive treatment outcomes.

Hemophagocytic Lymphohistiocytosis and Severe Hypoxemia in a Preterm Infant.

Hemophagocytic Lymphohistiocytosis and Severe Hypoxemia in a Preterm Infant.

Tuberculous Otitis Media in a Patient with Multiple Cerebral Tuberculomas: Case Report.

Tuberculous otitis media is a rare entity which requires high index of suspicion in an endemic country like India. A 38-year-old female with no prior history of tuberculosis or any predisposing factor presented to us with fever and altered sensorium. She was subsequently diagnosed to have disseminated tuberculosis with multiple cerebral tuberculomas. She complained of ear discharge which on further evaluation was established as smear positive tuberculous otitis media. This rare coexistence is seldom reported in literature.

RARE PRESENTATION OF EXTRA PULMONARY TB AS MULTIPLE INTRA CRANIAL TUBERCULOMAS- A CASE REPORT

TB of CNS is an uncommon yet highly devastating manifestation of TB. It has a hematogenous spread manifesting as meningitis, cerebritis,TB abscess, Tuberculomas and spinal arachnoiditis. We are reporting a case of 26yr old female person presented with short duration of headache, vomiting, neck pain and altered sensorium .Examination revealed left eye Ptosis and right sided classical hemiplegia . Investigations revealed multiple intracranial tuberculomas in MRI brain and feautures suggestive of miliary TB on CTchest . Multiple tuberculomas are rare presentation of intracranial TB and prognosis is poor in patients with multiple tuberculomas . But in our case clinical improvement is observed with Anti Tubercular Therapy

Central nervous system Tuberculomas in a patient with disseminated multi-drug resistant tuberculosis; A case report

Tuberculosis (TB) is one of the leading causes of death worldwide, particularly in low- and middle-income countries. Although Mycobacterium tuberculosis can involve any organ, most commonly the lung, central nervous system (CNS) tuberculosis is the most devastating form of the disease. Tuberculoma is the most common parenchymal lesion in CNS tuberculosis which could be found in any portion of the intracranial space. The global rates and numbers of drug resistant TB are rising. With increasing globalization, the spread of drug-resistant strains of TB has become a mounting global public health concern. We present a case of 27-year-old male with disseminated multi-drug resistant (MDR) TB who presented with neurological symptoms and multiple CNS Tuberculomas. The patient was started on regimen for Multi-drug resistant tuberculosis (MDR-TB), which allowed the serial resolution of intracranial tuberculomas. Keywords: Tuberculosis (TB), Multi-drug resistant (MDR) TB, Central nervous system (CNS) TB, Tuberculoma, MRI brain

A Rare Case of Multifocal Intracranial Gangliogliomas: Mimicking Tuberculomas

Gangliogliomas (GGs) are rare tumors of the central nervous system occurring in the young population (8.5-25 years). GGs are one of the most common cause of epilepsy associated with CNS tumors and significant proportion of them is refractory to antiepileptic medications. Multifocal gangliogliomas are very rare and only few handful cases are reported. A rare case of multiple spinal ganglioglioma has also been reported in the literature. We present a case of an adolescent girl who presented with multiple episodes of seizures. She was initially evaluated and diagnosed with multiple tuberculomas. She was managed with antiepileptics and antitubercular medications. Her seizure frequency had decreased; but despite prolonged and complete course of anti-tubercular treatment, the lesions were not subsiding in size. Antitubercular medications were restarted and subsequent scan showed progression in the size of the lesions; and hence biopsy was done from the largest lesion. Histopathology was suggestive of GG. Ganglioglioma can be multifocal and can mimic other lesions like tuberculosis, radiologically. Surgical excision of the lesion provides the best treatment option. It is still under consideration whether to remove all of the lesions or only ones with considerable size. She had another episode of seizure and is now planned for surgical excision of the other lesion.

Phenytoin induced cerebellar atrophy: A case report

The significant dose-related as well as idiosyncratic drug toxicity are encountered in pediatric practice occasionally due to the zero order pharmacokinetics and narrow therapeutic margin of phenytoin. Among uncommon side effects reported in patients with phenytoin exposure are cerebellar atrophy and at times its clinical presentation is masquerading as acute encephalitis. An unusual presentation of phenytoin toxicity in a 15-year-old girl suffering from multiple tubercular with seizure who developed bilateral cerebellar atrophy besides other features of Phenytoin toxicity over 3 years of drug use has been reported here along with possible approaches to minimize the possibility of dosing error in its prescription. Keywords: Phenytoin, Cerebellar atrophy, Multiple tuberculoma

Disseminated Mycobacterium tuberculosis following renal transplant: A case report

Abstract Miliary tuberculosis (TB) presents a major challenge following a renal transplant in humans. In the current report, we described a patient with disseminated TB following renal transplantation. The article presents the case of a 38-year-old man who presented an 8-month history of fever, chills, sweating, low-back pain and significant weight loss. Chest radiography and computed tomography (CT) scan showed miliary nodules distributed in the two lungs. The transbronchial lung biopsy revealed a granulomatous reaction with caseous necrosis. Magnetic resonance imaging (MRI) of the brain found multiple tuberculomas. Also, MRI of the lumbosacral was indicative of a psoas abscess. Therefore, miliary pulmonary, cerebral and spinal TB was confirmed. The patient was started on an anti-TB regimen and paravertebral aspiration was also done. The patient’s condition improved considerably. In conclusion, this case report can remind us of the importance of maintaining a high clinical suspicion and performing a thorough workup to establish a timely diagnosis and treatment of miliary TB.

The ring in the neck-managing paraparesis in cervical intramedullary tuberculoma: Inputs from a neurorehabilitation desk

Central nervous system (CNS) tuberculosis is a less common entity even in endemic countries like India. Involvement of spine is much less frequent than brain, but concurrent involvement of brain and spine by tuberculoma is rare. A 23-year-old female with paraparesis was diagnosed as having cervical ring enhancing lesion in MRI suggesting intramedullary tuberculoma along with long segment cervicodorsal edema. On brain screening she had multiple intracerebral tuberculomas without any evidence of tuberculosis elsewhere in the body. She was treated with a multidisciplinary approach including neurological management and neurorehabilitation, with remarkable clinical recovery. In presence of acute neurological deficit, early start of rehabilitation along with medical management can give outstanding results in terms of neuro-recovery and improvement of residual neurodeficits. Surgical intervention can be avoided in many cases.

Multiple Tuberculomas in a Transplanted Liver Mimicking Metastases of Unknown Origin

Liver transplant recipients are immunocompromised patients, and are often susceptible to bacterial, fungal and virus infections. We report the case of liver-only tuberculomas occurring eleven years following a deceased donor liver transplantation, that was initially interpreted as metastases of unknown origin. Interestingly, only a few such cases have been reported, usually within the first two years after transplantation, often when more aggressive immunosuppression is required. Although it is accepted that tuberculosis incidence among solid organ transplant recipients is higher when compared with the general population, its late onset after transplantation is very unusual.

Substantiation of indications and optimal time for carrying out low-invasive surgical interventions in treatment of patients with tuberculosis of lungs and pleura

Objective — to study and justify the indications and the optimal timing for minimally invasive surgical interventions in the treatment of patients with pulmonary tuberculosis (TB) and pleura.Materials and methods. A retrospective analysis was performed among patients and the clinical group. We analyzed 169 VATS surgical interventions in patients with pulmonary TB. All patients were examined and treated at the Department of Thoracic Surgery and Invasive Diagnostics of the SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky AMS of Ukraine» in the period from 2008 to 2018. The medical records of Department was studied and analyzed, as well as extracts of medical records from other hospitals.Results and discussion. The main indications for VATS interventions in patients with pulmonary tuberculosis are the so-called «small forms of tuberculosis», namely: tuberculoma 72 (55.4 %) cases, conglomerate tuberculoma 11 (8.5 %) cases, multiple tuberculomas 8 (6.2 %) patients and caseoma in 4 (3.1 %) patients. Surgical interventions (and VATS resections in particular) must be carried out in the phase of remission and compensation of the tuberculosis process. The optimal timing for VATS-resection of the lung in patients with pulmonary TB is 2 months from the beginning of TB treatment in category I (in the presence of sensitive TB) and 4—6 months from the beginning of a full-fledged TB treatment for category IV (in the presence of chemoresistant TB). That is, patients 2—4—6 months. treatment should be examined by thoracic surgeons for the necessity and possibility of surgical treatment. This is especially true for patients with no effect of conservative TB treatment for 4 months or more (the presence of constant or persistent bacterial excretion, the absence of positive radiological and/or microbiological dynamics).Delaying the patient’s direction to surgical treatment leads to a deterioration in the results of surgical treatment, an increase in the volume of resection interventions, more frequent palliative colapsosurgical interventions. The main indication for VATS plelectomy with pulmonary decortation is chronic tubercu­lous pleurisy of 1 st with a disease duration of up to 2 months.Conclusions. There are no clear terms for VATS interventions in patients. Surgical interventions are preferably carried out in the phase of remission and compensation of the tuberculosis process. According to urgent indications (pulmonary bleeding, intense pneumothorax, etc.), the acute phase of the tuberculosis process should not be an obstacle to the surgical elimination of symptoms that threaten the patient’s life. In special cases, with the steady progression of tuberculosis, which is localized within no more than one lung, you can resort to an extended resection or pulmonectomy. In these cases, intensive antimycobacterial therapy and correction of homeostasis are necessary.

A very young patient with Tubercular Meningitis and its complications

A case report on a successful management of an eight months old boy with Tubercular Meningitis with Multiple Tuberculoma in Brain with Obstructive Hydrocephalus with Left sided Lower motor neuron type Facial Palsy with Right Sided Hemiparesis. Tuberculous meningitis (TBM) is Mycobacterium tuberculosis infection of the Brain Meninges.1,2 In TBM inflammation occur mainly in the base of the brain and when the inflammation affect the brain stem subarachnoid area, cranial nerve roots then symptoms may occur like space-occupying lesions.3,4 TBM is more common in children than in adults, especially children aged 0-5 years.5 In children central nervous system tuberculosis usually presents as tubercular meningitis, post-tubercular meningitis hydrocephalus, and rarely a space-occupying lesions known as tuberculomas.6 TBM accounts for 2–5% of all active cases of Mycobacterium tuberculosis.7 Pulmonary infection coexists in 25–83% of TBM.8-10 Predominately primary CNS infection is found in children and leptomeningeal infection presents as meningitis, cranial nerve (CN) palsies (most commonly CN 2, 3, 4, and 7), and communicating hydrocephalus.11
 Northern International Medical College Journal Vol.10 (2) Jan 2019: 400-401

Multiple tuberculoma and choroid tubercles in a child with miliary tuberculosis

Miliary tuberculosis (TB) is a pathological name describing millet seed-sized (1–2 mm) granulomas in the various organs affected by tubercle bacilli. Miliary TB has a spectrum of manifestations that still perplex the most erudite and experienced clinicians and is a diagnostic and therapeutic challenge. Despite effective therapy being available, mortality from this disease has remained high. In children with miliary TB, chills, night sweats, hemoptysis, and productive cough have been reported less frequently, whereas peripheral lymphadenopathy and hepatosplenomegaly are more common compared with adults. Hereby, we present a case report of multiple tuberculoma and choroid tubercles in a child with miliary TB.

Paradoxical long segment myelitis in miliary pulmonary tuberculosis

A 32-year female presented with weakness of both lower limbs with bladder bowel involvement of 1-month duration. She was bedridden for 10 days. She was diagnosed with pulmonary tuberculosis and was on anti-tubercular therapy (ATT) for last 1 and half months. Cough and fever subsided but paraparesis with bladder bowel involvement occurred on ATT. Her routine blood parameters were normal. The chest X-ray shows bilateral miliary shadows. MRI spine shows long segment myelitis involving cervical and dorsal spinal cord with dural enhancement. MRI brain shows meningeal enhancement with multiple small tuberculomas. CSF shows 80 cells, 75% lymphocytes, 3725 mg% protein and 29 mg% sugar (corresponding blood sugar 97 mg%). Anti-nuclear antibodies and extractable nuclear antigen panel was negative. Aquaporin 4 antibodies report is awaited. Paradoxical worsening and dissemination in whole body is a common occurrence in miliary tuberculosis. Simultaneous involvement may be due to hematogenous spread. On the other hand, paradoxical reaction is not uncommon and warrant addition of steroid and evaluation for drug resistance. Our patient improved partially with steroid administration and continuation of ATT. We recommend screening of whole body for tuberculosis in cases with miliary pulmonary involvement.

102 Late-onset paradoxical reactions in neurotuberculosis presenting 18 months and 20 years after treatment

IntroductionParadoxical reactions (PRs) during treatment of neurotuberculosis are common but late-onset PRs after completion of anti-tuberculous treatment are reported very rarely. The management of late-onset PRs is challenging as excluding other diagnoses is difficult without invasive testing.MethodsTwo cases of late-onset PRs after treatment for neurotuberculosis are reported. The timing of onset, clinical and radiological features of these PRs are described and the diagnostic work up and outcomes after empiric immunosuppression reviewed.ResultsA 24-year-old woman presented with right-sided focal motor seizures 18 months after receiving anti-tuberculous treatment for neurotuberculosis. MRI showed enlargement of a previous left frontal tuberculoma with extensive oedema. A biopsy was not performed as the lesion involved eloquent brain and the patient declined a lumbar puncture. She was treated empirically with corticosteroids for six months and had clinical and radiological improvement.A 56-year-old woman presented with left leg weakness and numbness 20 years after treatment for multiple cerebral tuberculomas. MRI showed a new confluent area of T2 hyperintensity in the right frontal and parietal lobes. Cerebrospinal fluid was negative for acid-fast bacilli. She was treated with corticosteroids for 2 months with progressive improvement.ConclusionsLate onset PRs to neurotuberculosis can occur months to years after completing anti-tuberculous therapy. Recognising this entity is important so unnecessary treatments and brain biopsy may be avoided. Empiric immunosuppression with corticosteroids appears to be safe if early follow up and repeat imaging is arranged.