Abstract
We describe the unusual case of a young woman with a history of seizures and a granulomatous, likely tuberculous brain lesion that was surgically removed. She had an uneventful recovery without any additional therapy other than anti-epileptics. Seven years later, she presented during pregnancy with culture-confirmed tuberculous meningoencephalitis. This case highlights the spectrum of tuberculous central nervous system disease and the challenges in diagnosis.
Similar content being viewed by others
References
Girgis NI, Sultan Y, Farid Z, Mansour MM, Erian MW, Hanna LS, Mateczun AJ (1998) Tuberculosis Meningitis, Abbassia Fever Hospital - Naval Medical Research Unit No. 3 - Cairo, Egypt, from 1976–1996. Am J Trop Med Hyg 58(1):28–34
Dunlap NE, Bass J, Fujiwara P, Hopewell P, Horsburgh CR, Salfinger M, Simone PM (2000) Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 161(4):1376–1395
Thwaites G, Chau TTH, Mai NTH, Drobniewski F, McAdam K, Farrar J (2000) Tuberculous meningitis. J Neurol Neurosurg Psychiatry 68:289–299
Pagnoux C, Genereau T, Lafitte F, Congy F, Chiras J, Herson S (2000) Brain tuberculomas. Ann Med Intern 151(6):448–455
Strickland-Marmol LB, Fessler RG, Rojiani AM (2000) Necrotizing sarcoid granulomatosis mimicking an intracranial neoplasm: clinicopathologic features and review of the literature. Mod Pathol 13(8):909–913
Thomas G, Murphy S, Staunton H, O’Neill S, Farrell MA, Brett FM (1998) Pathogen-free granulomatous diseases of the central nervous system. Human Pathol 29(2):110–115
Silbert SW, Parker E, Horenstein S (1976) Whipple’s disease of the central nervous system. Acta Neuropathol 36(1):31–38
Finsterer J, Kladosek A, Nagelmeier I-E, Becherer A, Matula C, Stradal K-H, Wolf K, Czech T, Stanek G (2000) Chronic granulomatous meningitis With multiple cranial nerve lesions, hydrocephalus, stroke, sinus thrombosis, and epilepsy. South Med J 93(11):1108–1111
Pai M, Flores LL, Pai N, Hubbard A, Riley LW, Colford JM Jr (2003) Diagnostic accuracy of nucleic acid amplification tests for tuberculous meningitis: a systematic review and meta-analysis. Lancet Infect Dis 3:633–643
Bayindir C, Mete O, Bilgic B (2006) Retrospective study of 23 pathologically proven cases of central nervous system tuberculomas. Clin Neurol Neurosurg 108(4):353–357
Jackson RJ, Goodman JC, Huston DP, Harper RL (1998) Parafalcine and bilateral convexity neurosarcoidosis mimicking meningioma: case report and review of the literature. Neurosurg Clin N Am 42(3):635–638
Dastur HM (1983) Diagnosis and neurosurgical treatment of tuberculous disease of the CNS. Neurosurg Rev 6(3):111–117
Giese A, Kucinski T, Hagel C, Lohmann F (2003) Intracranial tuberculomas mimicking a malignant disease in an immunocompetent patient. Acta Neurochir 145(6):513–517
Wong CF, Yew WW, Wong PC, Lee J (1998) A case of concomitant tuberculosis and sarcoidosis with mycobacterial DNA present in the sarcoid lesion. Chest 114(2):626–629
Drake WP, Pei Z, Pride DT, Collins RD, Cover TL, Blaser MJ (2002) Molecular analysis of sarcoidosis tissues for mycobacterium species DNA. Emerg Infect Dis 8(11):1334–1341
Espinal MA, Reingold AL, Lavandera M (1996) Effect of pregnancy on the risk of developing active tuberculosis. J Infect Dis 173(2):488–491
Jana N, Vasishta K, Saha SC, Ghosh K (1999) Obstetrical outcomes among women with extrapulmonary tuberculosis. N Engl J Med 341(9):645–649
Capon A, Noterman J, Hubert JP, Klastersky J, Flament-Durand J (1975) Multiple tuberculomas of the brain. Report of a case. Acta Neurochir 32(3–4):303–312
Gasparetto EL, Tazoniero P, de Carvalho Neto A (2003) Disseminated tuberculosis in a pregnant woman presenting with numerous brain tuberculomas: case report. Arq Neuro-Psiquiatria 61(3B):855–858
Kingdom JC, Kennedy DH (1989) Tuberculous meningitis in pregnancy. Br J Obstet Gynaecol 96(2):233–235
Acknowledgments
We thank the laboratory staff in the Viral and Rickettsial Disease Laboratory and Contra Costa Public Health Laboratory and John L. McLellan Memorial Hospital. This study was supported by the Centers for Disease Control and Prevention Emerging Infections Program (U50/CCU915546-09).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Liu, C., Christie, L.J., Neely, J. et al. Tuberculous meningoencephalitis in a pregnant woman presenting 7 years after removal of a cerebral granuloma. Eur J Clin Microbiol Infect Dis 27, 233–236 (2008). https://doi.org/10.1007/s10096-007-0423-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-007-0423-0