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Central nervous system tuberculosis in immunocompetent patients: Two case reports with literature review
Jihad Boularab1, Kaoutar Imrani1, Hind Sahli1
1Central Radiology Department, Ibn Sina Hospital, Mohamed V University, Rabat, Morocco.
Insights
Central nervous system tuberculosis (CNS TB) is rare but severe. Early diagnosis and treatment of CNS TB in immunocompetent patients can lead to clinical improvement, despite diagnostic challenges.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Central nervous system tuberculosis (CNS TB) is a severe complication of tuberculosis, occurring in 5%-10% of extrapulmonary cases.
- Diagnosis is challenging due to non-specific clinical and radiological findings mimicking other neurological conditions.
- CNS TB has a high mortality and morbidity rate.
Observation:
- Two cases of isolated CNS TB in immunocompetent adults are presented.
- Both patients exhibited MRI findings indicative of meningitis and tuberculomas.
- One patient experienced cerebral ischemic infarction as a complication.
Findings:
- Despite delayed treatment, both patients showed clinical improvement following positive TB tests (PCR and QuantiFERON-TB Gold).
- This suggests that timely intervention can be effective even with diagnostic delays.
- The cases highlight the importance of considering CNS TB in differential diagnoses.
Implications:
- These findings underscore the need for increased awareness and improved diagnostic strategies for CNS TB.
- Early recognition and treatment are crucial for improving patient outcomes.
- Further research into optimizing diagnostic and therapeutic approaches for CNS TB is warranted.
Abstract:
Central nervous system tuberculosis (CNS) is a rare but extremely dangerous condition that has been reported in 5%-10% of extrapulmonary tuberculosis cases and accounts for approximately 1% of all tuberculosis cases. We present 2 cases of isolated central system tuberculosis in immunocompetent patients: a 57-year-old female and a 22-year-old young man, both of whom had MRI findings consistent with meningitis and tuberculomas and were complicated by cerebral ischemic infarction in the second case. Despite delaying therapy, both patients who had positive TB tests (PCR and QuantiFERON-TB Gold) nevertheless demonstrated clinical improvement. Although central nervous system tuberculosis has a high mortality rate and a high level of neurological morbidity, diagnosing it remains difficult because clinical symptoms and radiological findings can mimic other conditions such as pyogenic abscess, toxoplasmosis, sarcoidosis, and malignancy.
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