[A case of miliary tuberculosis complicated with SIADH, brain tuberculoma, and tuberculous meningitis].
A 46-year-old man complained fever, headache, and vertigo after he was given steroid for sudden deafness. He was diagnosed as miliary tuberculosis by his chest CT findings. After admission, 4 anti-tuberculous drugs (INH, RFP, SM, and PZA) were prescribed but his laboratory findings showed SIADH, which was difficult to treat, and steroid was readministered. Brain MRI, examined 2 months after admission, showed brain tuberculomas, and examination of cerebrospinal fluid revealed a diagnosis of tuberculous meningitis. Three months later, meningitis deteriorated transiently, however symptoms and findings improved by increasing steroid. Later, miliary tuberculosis and SIADH were cured, however, some tuberculomas grew larger gradually on brain MRI, and spinal MRI showed tuberculomas in the spinal cord. LVFX, high concentration in CSF, was added. At present (2 yrs after beginning the therapy), lesions in the brain and spinal cord improved but remain with the sequelae.
Takahara
Makoto
M
Department of Internal Medicine, National Nishi-Kofu Hospital, 3368, Yamamiya, Kofu-shi, Yamanashi, 400-0075, Japan. takahara@wkoufu.hosp.go.jp
D000995:Antitubercular Agents / Q000627:therapeutic use; D001927:Brain Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D004359:Drug Therapy, Combination; D006801:Humans; D007177:Inappropriate ADH Syndrome / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000008:administration & dosage; D011239:Prednisolone / Q000008:administration & dosage; D016896:Treatment Outcome; D014375:Tuberculoma / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014390:Tuberculosis, Meningeal / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014391:Tuberculosis, Miliary / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy
D000995:Antitubercular Agents; D011239:Prednisolone; D015242:Ofloxacin