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Disseminated tuberculosis with multiple intracerebral tuberculomas in a patient with anorexia nervosa
Jung Yong Ahn1, Jong Hee Chang, Keun Su Kim
1Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea. jyahn@yumc.yonsei.ac.kr
Objective:
Multiple tuberculous mycobacterial infections infrequently occur in immunocompromised patients. The malnutrition resulted from anorexia nervosa may contribute to the significant impairment of immunity. The authors present a 23-year-old female patient initially diagnosed with anorexia nervosa.
Method:
Immunological study revealed that helper T-cell (CD4) and cytotoxic T-cell (CD8) comprised 25 and 32%, respectively, with a CD4 to CD8 ratio of 0.78. Brain magnetic resonance imaging revealed various multiple rings enhancing lesions with edematous change in both cerebral and cerebellar hemispheres.
Results:
Open biopsy disclosed palisading epithelioid granuloma surrounded by inflamed granulation tissue. After anti-tuberculous therapy for 12 months, her weight was completely restored, but multiple intracranial tuberculomas were not completely disappeared.
Conclusion:
Disseminated tuberculous mycobacterial infections including multiple intracranial tuberculomas may be attributed to immunocompromised status in anorexia nervosa.
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