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[Brain tuberculoma in a 10-year-old child: the diagnosis is in the belly]
1Service de pédiatrie, CHR de La Réunion, BP 350, 97448 Saint-Pierre cedex, Réunion. anneletort@hotmail.fr
Insights
A child
Area of Science:
- Pediatrics
- Neurology
- Infectious Diseases
Background:
- Tuberculosis (TB) is a significant global health concern.
- Extrapulmonary and disseminated TB are rare in developed countries but remain a concern.
- BCG vaccination does not always prevent TB infection.
Observation:
- A 10-year-old child presented with headaches and seizures.
- Brain MRI revealed frontal lesions suggestive of a tumor.
- Abdominal mass and mesenteric adenopathy were detected.
- Tuberculin skin test was positive.
Findings:
- Biopsy confirmed tuberculosis, specifically tuberculoma.
- Treatment with anti-TB drugs led to resolution of brain lesions and adenopathy.
- Focal epilepsy was the only residual neurological deficit.
Implications:
- Highlights the importance of considering tuberculosis in pediatric neurological cases, even with BCG vaccination.
- Emphasizes the need for thorough systemic evaluation to locate accessible TB lesions.
- Advocates for avoiding invasive neurosurgery when extrapulmonary TB is suspected and treatable.
Abstract:
We report the case of a 10-year-old child from Reunion Island who was hospitalized because of headaches and partial convulsive fits. The brain MRI showed several conglomerated right frontal lesions suggestive of a tumor process. This girl, vaccinated with BCG, had familial risk factors for tuberculosis and a 20-mm tuberculin intradermo-reaction. Given the palpation of an abdominal mass, a thoracoabdominal scan was done, which revealed the presence of mesenteric adenopathies. Their biopsy confirmed the diagnosis of tuberculosis without having to perform neurosurgery. A 2-month quadritherapy and a 10-month dual therapy against tuberculosis led to the disappearance of brain damage and mesenteric adenopathies, with focal epilepsy the only sequela. The tuberculosis incidence in Reunion Island (8/100,000) is comparable with the French average, but the island is surrounded by high-endemic countries. Tuberculomas were responsible for one-third of expanding intracranial lesions in Europe in 1933, and their incidence remains high in developing countries. Even though extrapulmonary or disseminated tuberculosis has become rare in children in industrialized countries, this diagnosis must be kept in mind, in spite of vaccination. In accordance with international guidelines, this case report shows the importance of a systematic extensive check-up (cervical, thoracic and abdominopelvic) when brain tuberculosis is suspected in order to find more accessible tuberculosis lesions and to avoid the side effects of a brain biopsy.
