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Numerous Asymptomatic Brain Tuberculomas Complicated by Fatal Tuberculous Meningitis

Irakli Alavidze1, Mariam Shubitidze1, Gvantsa Khodeli2

  • 1Aieti Medical School, David Tvildiani Medical University, Tbilisi, GEO.

Cureus
|July 26, 2024
PubMed

Insights

A rare case of a 55-year-old man with asymptomatic tuberculosis (TB) involving at least 34 central nervous system tuberculomas is presented. He later developed tuberculous meningitis, highlighting public health challenges in managing disseminated TB.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Public Health

Background:

  • Tuberculosis (TB) remains a significant global infectious disease challenge.
  • HIV coinfection elevates the risk of extrapulmonary TB, particularly affecting the central nervous system (CNS).
  • Central nervous system TB (CNS-TB) commonly manifests as tuberculous meningitis or tuberculomas.

Observation:

  • A 55-year-old male presented with a rare asymptomatic presentation of numerous (≥34) CNS tuberculomas of varying sizes.
  • The patient's clinical course was complicated by the eventual development of tuberculous meningitis.
  • This case underscores the potential for asymptomatic, disseminated CNS tuberculomas.

Findings:

  • The asymptomatic carriage of a large number of tuberculomas is an infrequently reported clinical scenario.
  • The progression from asymptomatic tuberculomas to fatal tuberculous meningitis highlights disease dynamism.
  • The patient's case suggests potential underlying public health issues contributing to complex clinical outcomes.

Implications:

  • This case emphasizes the need for vigilance in diagnosing CNS-TB, even in asymptomatic individuals.
  • It highlights the importance of considering public health factors alongside clinical management in complex TB cases.
  • Further research into the interplay of public health challenges and clinical progression in CNS-TB is warranted.
Keywords:
central nervous system tuberculosisgeorgiaglobal health policyhiv aidsimmunosuppresionintracranial tuberculomamedication noncompliancepublic healthtuberculous meningitis (tbm)

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