Asymptomatic pons tuberculoma in an infant with miliary tuberculosis

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Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
06:15

Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus

Published on: March 6, 2019

Gulnar Uysal1, Tugba Gursoy, Umut Altunc

  • 1Department of Pediatric Infectious Diseases, Ankara Children's Hospital, Social Security Institution, Ankara, Turkey. tugbagursoy@superonline.com

Saudi Medical Journal
|August 30, 2005
PubMed

Insights

Miliary tuberculosis can affect the central nervous system (CNS) in infants, even without neurological symptoms. Early CNS investigation is crucial for diagnosing these rare brainstem tuberculomas in infants with miliary tuberculosis.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Neurology

Background:

  • Miliary tuberculosis (TB) results from disseminated Mycobacterium tuberculosis.
  • It comprises 1.5% of all TB cases, predominantly affecting infants due to immature immunity.
  • Central nervous system (CNS) involvement is a recognized complication.

Observation:

  • A 4.5-month-old infant initially diagnosed with cytomegalovirus pneumonia later developed miliary TB.
  • Despite normal neurological examination and cerebrospinal fluid, cranial MRI revealed contrast-enhanced nodular lesions.
  • Lesions were observed in the brainstem (pons), cerebellum, and right parietal region.

Findings:

  • This case highlights rare localized CNS tuberculosis (tuberculomas) in an infant.
  • Brainstem tuberculomas are exceptionally rare, accounting for only 4% of CNS TB.
  • Cranial MRI identified unexpected CNS lesions in miliary TB without overt neurological signs.

Implications:

  • Emphasizes the necessity of thorough CNS investigation in infants diagnosed with miliary tuberculosis, irrespective of neurological findings.
  • Suggests that subtle or absent neurological signs should not preclude CNS evaluation in pediatric miliary TB.
  • Underscores the diagnostic value of advanced neuroimaging in identifying CNS involvement in disseminated infections.

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