Diagnostic dilemma and therapeutic non-compliance in a case of intracranial tuberculoma.
A case of extensive intracranial tuberculoma is presented. The patient had been treated for 5 years with a standard antituberculosis regimen but she had been grossly non-compliant. This had led to emergence of multi-resistant Mycobacterium tuberculosis producing progressive disease and extensive cranial nerve damage and proptosis. The unusual CT and angiographic appearances cast doubt on the original diagnosis and a brain biopsy was necessary. Mycobacterium tuberculosis resistant to isoniazid, rifampicin, ethambutol, ethionamide, pyrazinamide, clofazimine and PAS was cultured from the brain biopsy specimen and from an associated groin abscess. A novel regimen of isoniazid, cycloserine, amikacin and ciprofloxacin produced clinical improvement of symptoms and radiological resolution.
Ellis
M E
ME
Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
Halim
M A
MA
Coates
R K
RK
al-Hokail
A A
AA
Hussain Qadri
S M
SM
el-Yazigi
A
A
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000097:blood; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D014057:Tomography, X-Ray Computed; D016312:Treatment Refusal; D016862:Tuberculoma, Intracranial / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy
D000995:Antitubercular Agents; D002939:Ciprofloxacin