title: Cerebellar abscess and syringomyelia due to isoniazid-resistant Mycobacterium tuberculosis.
abstract: A 19-year-old immunocompetent man was admitted to hospital with diplopia, nausea, vomiting and change in mental status. The patient had a history of tuberculous meningitis that was diagnosed at another hospital 6 months before the present admission, and at that time anti-tuberculosis treatment was initiated using a first-line drug combination. A computed tomography (CT) scan of the brain revealed non-communicating hydrocephalus. A ventriculo-peritoneal shunt was inserted surgically. Two months later, the patient was hospitalized again for fever, dysphagia and left hemiparesis. At that time, his cranial CT findings were within normal limits; however, magnetic resonance imaging (MRI) revealed an irregular multilocular peripheral contrast-enhancing lesion in the posterior fossa. The abscess was surgically drained. The presence of acid-fast bacilli in the abscess material was demonstrated by Ziehl-Neelsen staining. Mycobacterium tuberculosis grew on Lowenstein-Jensen culture medium, and the strain was found to be resistant to isoniazid. One month after the operation, the patient became quadriparetic. Cervical MRI revealed a cervico-thoracic syringomyelitic cavity, after which a syringoperitoneal shunt was placed. Treatment with four drugs was continued for 10 months, and then treatment with three drugs for a total period of 18 months. The patient recovered, with residual quadriparesis. Even though very rare, isoniazid-resistant M. tuberculosis may be the causative agent of progressive tuberculosis.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Inonu University School of Medicine, Turgut Ozal Medical Centre, 44280 Malatya, Turkey. yersoy@inonu.edu.tr
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Ersoy
authors.forename: Ozkan
authors.initials: O
authors.lastname: Ates
authors.forename: Cagatay
authors.initials: C
authors.lastname: Onal
authors.forename: Ayse Dinc
authors.initials: AD
authors.lastname: But
authors.forename: Suleyman Rustu
authors.initials: SR
authors.lastname: Cayli
authors.forename: Yasar
authors.initials: Y
authors.lastname: Bayindir
authors.forename: Riza
authors.initials: R
authors.lastname: Durmaz
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001922:Brain Abscess / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D002526:Cerebellar Diseases / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D002557:Cerebrospinal Fluid Shunts; D024881:Drug Resistance, Bacterial; D004977:Ethambutol / Q000627:therapeutic use; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery; D007538:Isoniazid / Q000494:pharmacology* / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D011782:Quadriplegia / Q000209:etiology; D013595:Syringomyelia / Q000382:microbiology*; D014057:Tomography, X-Ray Computed; D014390:Tuberculosis, Meningeal / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology
chemical_list: D000995:Antitubercular Agents; D004977:Ethambutol; D007538:Isoniazid