Intracranial tuberculomas diagnosed with Xpert MTB/RIF Ultra assay of formalin-fixed paraffin-embedded brain tissues and treated with an optimized antituberculosis regimen: A case report
Wang Jin,
Chen Qifu,
Yu Hong,
Huang Hua,
Li Xuelin,
Wang Xiaomin,
Lu Shuihua,
Fang Mutong
Affiliations
Wang Jin
Division of Pulmonary Diseases Department, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, Shenzhen, Guangdong, China; National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, Guangdong, China
Chen Qifu
Department of Neurosurgery, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, Shenzhen, Guangdong, China
Yu Hong
Department of Pathology, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, Shenzhen, Guangdong, China
Huang Hua
Department of Radiology, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, Shenzhen, Guangdong, China
Li Xuelin
Department of Clinical Laboratory, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, Shenzhen, Guangdong, China
Wang Xiaomin
National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, Guangdong, China
Lu Shuihua
Division of Pulmonary Diseases Department, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, Shenzhen, Guangdong, China; National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, Guangdong, China; Corresponding author. Division of Pulmonary Diseases Department, The Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, 518112, Guangdong, China.
Fang Mutong
Division of Pulmonary Diseases Department, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, Shenzhen, Guangdong, China; National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen, Guangdong, China; Corresponding author. Division of Pulmonary Diseases Department, The Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Disease, Southern University of Science and Technology, Shenzhen 518112, Guangdong, China.
Diagnosis of intracranial tuberculoma remains a challenge due to its rarity, non-specific clinical presentation, and radiological findings. Herein, we describe a case of intracranial tuberculomas in a male diabetic patient who presented headache and vomiting on admission. Neuroimaging findings indicated multiple ring contrast-enhanced lesions with extensive perilesional edema. However, a cerebrospinal fluid (CSF) examination was normal. When a biopsy of brain lesions was performed, pathological characteristics of tuberculosis were absent and acid-fast staining was negative. A tuberculosis diagnosis was subsequently obtained from an Xpert MTB/RIF Ultra assay of formalin-fixed paraffin-embedded brain tissue. The patient was treated with an optimized anti-tuberculosis regimen which included high-dose intravenous administration of rifampicin and isoniazid, and oral administration of linezolid. The patient recovered well and exhibited marked clinical improvement. This case report demonstrates that when CSF analysis does not indicate the presence of intracranial tuberculomas, analysis of formalin-fixed paraffin-embedded brain tissue specimens with the Xpert MTB/RIF Ultra assay may be able to confirm a diagnosis. Furthermore, a high dose of rifampicin and isoniazid plus linezolid may improve patient outcome.
