title: [Multiple meningeal and cerebral involvement revealing multifocal tuberculosis in an immunocompetent patient].
abstract: Tuberculosis is a public health problem in Morocco. Central nervous system involvement is nevertheless rare, occurring in the context of multifocal or miliary tuberculosis. However, it may be a mode of revelation even in an immunocompetent subject. We report the case of a 30-year old man with language disorder accompanied by significant impairment of general condition. Clinical examination showed Broca's motor aphasia, right-sided pyramidal syndrome and latero-cervical adenopathies. HIV serologic test was negative. Brain MRI showed lesions associating multiple intracranial tuberculomas and meningoencephalitis. Thoracic CT scan showed multiple pulmonary micronodules, cavity wall thickening and bronchiectasia of the right fowler and culmen. Lymph node biopsy revealed typical architecture of a TB granuloma. The diagnosis of multifocal tuberculosis was retained and the patient received anti-bacillary therapy associated with corticosteroid therapy with good clinico-radiological evolution. This study is peculiar due to the appearance and the seat of tuberculous lesions on brain imaging, the absence of immunodeficiency, a good evolution under treatment. It highlights the role of active and exhaustive assessment of associated extracerebral tuberculous infection in the case of cerebromeningeal lesion suggestive of tuberculosis.
authors.affiliation: Service de Neurlogie, Hopital Militaire Moulay Ismail Meknès, Meknès, Maroc.
authors.forename: Tarik
authors.initials: T
authors.lastname: Boulahri
authors.affiliation: Service de Neurlogie, Hopital Militaire Moulay Ismail Meknès, Meknès, Maroc.
authors.forename: Abdellah
authors.initials: A
authors.lastname: Taous
authors.affiliation: Service de Neurlogie, Hopital Militaire Moulay Ismail Meknès, Meknès, Maroc.
authors.forename: Maha Aït
authors.initials: MA
authors.lastname: Berri
authors.affiliation: Service de Neurlogie, Hopital Militaire Moulay Ismail Meknès, Meknès, Maroc.
authors.forename: Imane
authors.initials: I
authors.lastname: Traibi
authors.affiliation: Service de Neurlogie, Hopital Militaire Moulay Ismail Meknès, Meknès, Maroc.
authors.forename: Abdelhadi
authors.initials: A
authors.lastname: Rouimi
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007121:Immunocompetence; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008590:Meningoencephalitis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D009018:Morocco; D014057:Tomography, X-Ray Computed / Q000379:methods; D014375:Tuberculoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D016862:Tuberculoma, Intracranial / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D014390:Tuberculosis, Meningeal / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology
chemical_list: D000305:Adrenal Cortex Hormones; D000995:Antitubercular Agents
keywords: Intracranial tuberculoma; brain MRI; meningoencephalitis; multifocal tuberculosis