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TB Meningitis and TB Peritonitis: Abdominal Pseudocyst and VP-Shunt Link

Manzoor Ahmed1, Essameldin Ali ElGamal2, Anwar Ahmad2

  • 1Department of Radiology, Sheikh Khalifa Medical City, Abu Dhabi, UAE.

Case Reports in Radiology
|June 12, 2019
PubMed

Insights

Tuberculosis meningitis (TBM) can spread through ventriculoperitoneal shunts (VPS), causing TB peritonitis. This case highlights a rare complication of multidrug-resistant TBM dissemination via VPS.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Tuberculosis meningitis (TBM) is a severe extrapulmonary form of tuberculosis with high morbidity and mortality.
  • TBM commonly presents with leptomeningitis, hydrocephalus, infarcts, and tuberculomas, often visualized on MRI and CT scans.
  • Hydrocephalus secondary to TBM is frequently managed with ventriculoperitoneal shunting (VPS), which can be associated with complications like shunt malfunction.

Observation:

  • A case of multidrug-resistant TBM with spinal involvement was observed.
  • The disease disseminated via the VPS, leading to tuberculous peritonitis (TBP).
  • TBP manifested as a large abdominal pseudocyst around the VPS catheter tip, causing shunt malfunction.

Findings:

  • This report details the first instance of ventriculoperitoneal shunting (VPS) acting as a conduit for the spread of tuberculosis.
  • The dissemination resulted in tuberculous peritonitis (TBP), a relatively uncommon presentation.
  • No other extra-central nervous system (CNS) sites of tuberculosis disease were identified.

Implications:

  • This case underscores a novel route of tuberculous dissemination, emphasizing the potential for VPS to facilitate spread.
  • It highlights the importance of considering VPS-related complications in patients with TBM and neurological symptoms.
  • Further investigation into the mechanisms and prevention of VPS-associated TB spread is warranted.

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