title: Posterior fossa tuberculoma in a Huichol native Mexican child: a case report.
abstract: BACKGROUND
  Tuberculosis is a major health concern in Mexico, especially among the native population. Tuberculomas are a frequent and severe complication of pediatric tuberculosis, these are observed as tumors in neuroimaging studies but are often not diagnosed adequately.
  
  
  METHODS
  We present a case of a 12-year-old native Mexican girl Huichol ethnicity diagnosed with a large posterior fossa tuberculoma found by imaging. This tuberculoma was surgically removed. Histopathologic examination and staining with hematoxylin and eosin, and Ziehl-Neelsen techniques of the surgical specimen were performed. Cerebrospinal fluid was analyzed by using the newly available Xpert® MTB/RIF assay (Cepheid, Sunnyvale CA, USA). Granulomatous inflammation with central caseous necrosis surrounded by edematous brain with reactive gliosis and acid-fast bacilli were revealed on histopathologic analysis. Mycobacterium tuberculosis DNA susceptible to rifampicin was detected in the patient's cerebrospinal fluid and the patient was started on anti-tuberculosis treatment. The girl continued to show severe neurologic damage despite surgery and anti-tuberculosis treatment, and she eventually died of respiratory complications.
  
  
  CONCLUSIONS
  Our case highlights the need for early confirmation of tuberculoma diagnosis by molecular assay so that timely treatment can be initiated to prevent severe brain damage. Furthermore, it emphasizes the need to consider tuberculomas in the differential diagnosis of children with neurologic symptoms living in areas of high tuberculosis incidence and those belonging to native populations in developing countries.
authors.affiliation: Servicio de Hematología y Oncología Pediátrica, Unidad de Infectología, Hospital Civil de Guadalajara, Instituto de Investigación en Cáncer Infantil y de la Adolescencia, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico. grisesme@yahoo.com.mx.
authors.forename: Griselda
authors.initials: G
authors.lastname: Escobedo-Meléndez
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Portillo-Gómez
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Andrade-Ramos
authors.forename: David
authors.initials: D
authors.lastname: Bocanegra
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Mercado-Pimentel
authors.forename: Luis
authors.initials: L
authors.lastname: Arredondo
authors.forename: Dara
authors.initials: D
authors.lastname: Torres
authors.forename: Miguela A
authors.initials: MA
authors.lastname: Caniza
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D005006:Ethnicity; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008800:Mexico; D016862:Tuberculoma, Intracranial / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents