A malignant disseminated tuberculosis: concurrent intracranial tuberculosis with skipped multilevel spondylitis in a young immunocompetent patient

Abstract

Background/aim. Mycobacterium tuberculosis (M. tuberculosis) infection can cause pulmonary and extrapulmonary tuberculosis (TB), resulted from hematogenous or lymphatic dissemination of the bacteria. Disseminated TB is characterized by the presence of two or more non-contiguous sites from the spread. Dissemination to the central nervous system (CNS TB) has several manifestations that can cause devastating neurological complications. Several predisposing factors include older age, human immunodeficiency virus (HIV) coinfection, and pharmacological immunosuppression. As the manifestation of CNS TB itself is rare, diagnosing it remains a challenge. Prompt antituberculosis treatment is needed to improve patient’s outcome. This paper aims to present a rare case of malignant disseminated TB in a young immunocompetent patient. Case. This case presents an immunocompetent 17-year-old male with weakness in the four extremities. Through comprehensive history taking and examination, the patient was diagnosed with malignant disseminated TB, presenting as cerebellar tuberculoma, tuberculous meningitis, and multiple skipped level spondylitis TB; and concurrent pulmonary TB. Then, the patient underwent a surgery for the cervical lesion and was started on antituberculosis treatment in combination with corticosteroid. After the treatment, the patient’s motoric and sensoric functions improved and he was able to urinate and defecate normally. Conclusion. This case demonstrates the importance of considering disseminated TB in the differential diagnosis of a patient with neurological deficits, regardless of the fact that the patient is young and immunocompetent. Prompt diagnosis and rapid initiation of treatment can improve the patient’s outcome.

Cerebellar tuberculoma in an immunocompetent patient

“…Tuberculous meningitis (TBM) is the most common form of CNS TB with a lower incidence than intracranial tuberculoma, tuberculous brain abscess, tuberculous encephalopathy, spinal cord tuberculous meningitis, non-osseous spinal cord tuberculosis, Pott's paraplegia, and Pott's spine (Chen et al, 2018), (Israr Khan et al, 2019). Infection of MTB can result in the hematogenous or lymphatic spread of the pathogens, which can lead to pulmonary and extrapulmonary TB (Sutantoyo and Sugianto, 2022). CNS tuberculoma is a rare cause of intracranial masses; they are granulomas that form from an inflammatory response to MTB infection, with 3-4% of cases involving the cerebellum (Bouali et al, 2020), (Er et al, 2018).…”

Enzyme-linked immunospot assay and metagenomic sequencing of Mycobacterium tuberculosis, coagulopathy symptoms, and pancytopenia testing for characterization of pulmonary tuberculosis: case report and literature review

“…Pulmonary TB is an infectious respiratory disease caused by MTB (1)(2)(3). A typical patient with pulmonary TB may have respiratory symptoms such as cough, sputum, and hemoptysis and constitutional symptoms such as night sweats, fatigue, loss of appetite, and weight loss (4)(5)(6). However, a significant proportion of TB patients do not have these specific clinical manifestations or even obvious symptoms, which remains a challenge for early detection and prompt treatment (7)(8)(9).…”