title: Isoniazid-resistant intracranial tuberculoma treated with a combination of moxifloxacin and first-line anti-tuberculosis medication.
abstract: We report a case of a previously healthy 23-year-old Somalian care assistant. She presented with a 4 month history of persistent occipital headaches associated with intermittent nausea and vomiting. Computed tomography and magnetic resonance imaging of the brain showed a large enhancing lesion in the right cerebellar hemisphere with surrounding ring lesions, suggestive of an intracranial neoplasm with metastases. However, tuberculoma of the brain was confirmed based on histology of the excision biopsy and cerebrospinal fluid (CSF) culture results: Mycobacterium tuberculosis resistant to isoniazid (INH) with sensitivity to other standard drugs, including fluoroquinolones, was cultured from CSF. No primary focus to suggest spread from elsewhere was found. The patient was treated successfully with moxifloxacin, rifampicin, pyrazinamide and ethambutol. Isolated INH-resistant intracranial tuberculoma is rare in adults. It can mimic other intracranial masses and should be kept in mind, especially in populations with a high risk of tuberculosis. Clinical use of moxifloxacin in INH-resistant tuberculomas is limited in humans and this case demonstrates that moxifloxacin may be an effective alternative treatment.
authors.affiliation: Department of Chest Medicine, Castlehill Hospital, Cottingham, UK.
authors.forename: Wha-Yong
authors.initials: WY
authors.lastname: Lee
authors.affiliation: Department of Infectious Diseases, Castlehill Hospital, Cottingham, UK.
authors.forename: Mirella
authors.initials: M
authors.lastname: Ling
authors.affiliation: Department of Chest Medicine, Castlehill Hospital, Cottingham, UK.
authors.forename: Gavin
authors.initials: G
authors.lastname: Anderson
authors.affiliation: Department of Neurosurgery, Castlehill Hospital, Cottingham, UK.
authors.forename: Shailendra
authors.initials: S
authors.lastname: Achawal
authors.affiliation: Department of Infectious Diseases, Castlehill Hospital, Cottingham, UK.
authors.forename: Hiten K
authors.initials: HK
authors.lastname: Thaker
mesh_terms: D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000494:pharmacology; D001372:Aza Compounds / Q000008:administration & dosage*; D001706:Biopsy; D001921:Brain / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D002555:Cerebrospinal Fluid / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004977:Ethambutol / Q000008:administration & dosage; D005260:Female; D024841:Fluoroquinolones; D006651:Histocytochemistry; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology; D008279:Magnetic Resonance Imaging; D000077266:Moxifloxacin; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D011718:Pyrazinamide / Q000008:administration & dosage; D011804:Quinolines / Q000008:administration & dosage*; D012293:Rifampin / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016862:Tuberculoma, Intracranial / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D011718:Pyrazinamide; D004977:Ethambutol; D000077266:Moxifloxacin; D007538:Isoniazid; D012293:Rifampin