[Central nervous tuberculosis in patients non-VIH: seven case reports].
OBJECTIVE
Tuberculosis involving the central nervous system (CNS) is rarely observed in non immuno-compromised hosts. We report herin the various clinical, biological and radiological manifestations observed in 7 patients with CNS tuberculosis.


METHODS
Clinical and biological records of 7 patients with CNS tuberculosis were retrospectively studied. All patients had encephalic CT-scan and MRI in the course of the disease.


RESULTS
5 women and 2 men with a mean age of 38.4 years initially initially presented with headache (n = 6), fever (n = 5), meningeal irritation (n = 3), localizing neurological signs (n = 1). Lumbar punction revealed lymphocytic meningitis (n = 6/7). Mycobacterium tuberculosis or bovis was isolated in 3 patients only. Cerebral tomodensitography or magnetic resonance imaging were initially normal in most of cases (n = 4/7), but discovered in the course of disease basilar meningitis (n = 6), hydrocephalus (n = 6), abcess or tuberculoma (n = 4). In all the patients, initiation of the treatment was complicated by clinical and/or biological deterioration, called paradoxal reaction, leading in all cases to glucocorticoid adjunction, with various final results. Indeed, 4 patients developed neurological sequelae. No patient died.


CONCLUSIONS
CNS tuberculosis is a rare disease in non immunocompromised patients whose diagnostic may be difficult due to the absence of specific clinical symptoms, negative initial radiological examination, as well as delayed and often negative bacterial isolation. Paradoxal reaction appeared to be frequent despite specific antibiotherapy and underlines the beneficial effects of addictive corticosteroids.
Mazodier
K
K
Service de médecine interne, CHU de la Conception, 147, boulevard Baille, 13385 cedex 05, Marseille, France.
Bernit
E
E
Faure
V
V
Rovery
C
C
Gayet
S
S
Seux
V
V
Donnet
A
A
Brouqui
P
P
Disdier
P
P
Schleinitz
N
N
Kaplanski
G
G
Veit
V
V
Harlé
J-R
JR
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007121:Immunocompetence; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D016862:Tuberculoma, Intracranial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D020306:Tuberculosis, Central Nervous System / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D014390:Tuberculosis, Meningeal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology
D000305:Adrenal Cortex Hormones; D000995:Antitubercular Agents