Miliary Tuberculosis with Central Nervous System Involvement in Paediatric Patient

  • Sandis Kovaļovs (Speaker)
  • Pretkalniņa, D. (Co-author)
  • Marija Luīze Kalniņa (Co-author)
  • Guntis Rozentāls (Co-author)

Activity: Talk or presentation types › Poster presentation

Description

Miliary tuberculosis is a form of extrapulmonary tuberculosis(TB) due to hematogenous dissemination of mycobacteria and according to published data, it occurs in about 1 - 2% of all cases of TB. Clinical manifestations are usually nonspecific and vary from organ system affected. We report a case with presentation of miliary tuberculosis with severe central nervous system involvement. Patient, 17 years old, previously healthy, female was admitted to Children's Clinical University Hospital with complaints of subfebrile body temperature, dizziness and gait instability. On examination, the patient had ptosis of the right eyelid and ataxia with right arm and leg. Computed tomography(CT) was performed where structural brainstem and white matter hypodense abnormalities were detected with differential diagnosis between inflammatory process or neoplasm. Magnetic resonance imaging(MRI) of the brain was performed which indicated meningoencephalitis. Cerebrospinal fluid(CSF) analysis showed pleocytosis (44 cells/uL) with lymphocytic predominance, increased protein(2,15g/L) and decreased glucose(1,11mmol/L) levels. CT of the lungs showed miliary tuberculosis. Therapy with rifampicin, isoniazid, pyrazinamide, ethambutol was started. Patient had a positive Quantiferon-TB test, M. tuberculosis DNA was detected in urine, feces, CSF and sputum. 4 days after admission, the patient had a rapid decline of consciousness, CT showed hydrocephalus due to obstruction of cerebral aqueduct. Ventriculoperitoneal shunting was performed. In the following days a stroke in the left middle cerebral artery occurred due to TB related vasculitis. On discharge, the patient had sensorimotor aphasia, asymmetric tetraparesis, elevated deep tendon reflexes and pathological reflexes on both sides. Despite the fact that nowadays the meningoencephalitis caused by tuberculosis is very rare, we should keep in mind such a possibility to be able to diagnose and start therapy as soon as possible. Even with fast diagnosis and initiation of treatment, mortality and serious neurological sequelae rates continue to be high in central nervous system tuberculosis.. .. .. .
Period29 Mar 2023
Event titleRSU International Research Conference 2023: Knowledge for Use in Practice
Event typeConference
OrganiserRīga Stradiņš University
LocationRiga, LatviaShow on map
Degree of RecognitionInternational

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