[Cerebral and pulmonary miliary tuberculosis in an immunocompetent patient: aggravation in an adequately treated patient].
BACKGROUND
Extrapulmonary localizations are observed in 20% of tuberculosis cases, mainly in immunosuppressed patients. Prognosis is poor in case of relatively uncommon cerebral localizations and miliary dissemination, especially if treatment is initiated in late stages. We report a case of disseminated tuberculosis associated with cerebral and pulmonary localizations in an immunocompetent patient. THe disease progressed despite adapted treatment.


METHODS
A young immunocompetent man with an uneventful history developed miliary tuberculosis with pulmonary localizations visualized on the computed tomography (CT) of the thorax. Brain CT was normal, but magnetic resonance imaging revealed several intracranial lesions. The disease course was marked by development of neurological symptoms and progression of the cerebral lesions after one month of treatment. No evidence of therapeutic failure (insufficient dosing, non-compliance, primary resistance) could be identified.


CONCLUSIONS
Magnetic resonance imaging provides a more precise evaluation of tuberculosis lesions in the brain. Early antituberculosis therapy associated with corticosteroids can improve prognosis. Clinicians should be aware that cerebral lesions may continue to progress despite appropriate treatment, a course which is not satisfactorily explained by any current pathogenic hypothesis.
Service de Médecine interne et Maladies infectieuses, CHU A. Michallon, Grenoble.
G
G
Gavazzi
O
O
Bouchard
A
A
Bosseray
P
P
Leclerq
M
M
Micoud
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D018450:Disease Progression; D004359:Drug Therapy, Combination; D006801:Humans; D007121:Immunocompetence; D008279:Magnetic Resonance Imaging; D008297:Male; D013256:Steroids; D014057:Tomography, X-Ray Computed; D016862:Tuberculoma, Intracranial / Q000175:diagnosis* / Q000188:drug therapy*; D014391:Tuberculosis, Miliary / Q000175:diagnosis* / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D000995:Antitubercular Agents; D013256:Steroids
Miliaire tuberculeuse cérébrale et pulmonaire chez un patient immunocompétent: aggravation sous traitement adapté.