Tuberc Respir Dis.  2008 Feb;64(2):153-157.

A Case of Different Response of Miliary Lung and Intracranial Nodules to Antituberculous Therapy

• Park KY
• Lee HJ
• Jung JW
• Choi YH
• Nam SB
• Ahn SH
• Kim CH
• Lee JC

Abstract

Although a paradoxical response of tuberculosis to antituberculous therapy is not a rare phenomenon, it can be a clinical challenge to differentiate a paradoxical response from treatment failure. A 25-year-old woman was admitted for miliary lung nodules and multiple intracranial nodules. Antituberculous treatment was started with a preliminary diagnosis of tuberculosis based on the history and clinical findings. After one month, the miliary lung nodules improved while the intracranial nodules increased in size and number. Based on a stereotactic biopsy, it was confirmed that the intracranial lesions were tuberculomas. Although the therapeutic regimen was not changed, the symptoms eventually were ameliorated and the intracranial nodules improved two months later.

Keyword

Tuberculosis; Paradoxical response; Intracranial tuberculoma

MeSH Terms

Adult
Biopsy
Female
Humans
Lung
Treatment Failure
Tuberculoma
Tuberculoma, Intracranial
Tuberculosis

Figure

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  Figure 1 (A) Chest X-ray on admission day before antituberculous chemotherapy. Diffuse fine nodules of both lungs were found. (B) Disseminated fine nodules on whole lung fields improved after antituberculous chemotherapy for 1 month. (C) Chest X-ray 2 months after antituberculous chemotherapy. Previous detected fine nodules had completely resolved.

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  Figure 2 (A) T1-weighted axial view of brain MRI following gadolinium enhancement on admission day before antituberculous chemotherapy. Multiple small ring enhancing nodules in both cerebrum and brain-stem were found (arrows). (B) Brain MRI taken one month after antituberculous chemotherapy showed increased size and number of multiple nodules in both cerebrum and brain-stem, especially in left parietotemporal lobes and left thalamus with peritumoral edema (arrows). (C) Previously detected multiple nodules in both cerebrum and brain-stem had near completely resolved two months after antituberculous chemotherapy.

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  Figure 3 Stereotactic biopsy of brain revealed granulomas without central necrosis or giant cells (H&E stain, ×100).

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