Tuberculoma: Difference between revisions
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==Background== |
==Background== |
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=== Pathophysiology === |
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* Collection of granulomatous tissue that results from hematogenous spread of [[Mycobacterium tuberculosis]] |
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* They are a granulomatous lesion of epithelioid cells and Langerhans giant cells surrounded by lymphocytes |
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* Progress from non-caseating to solid with central caseation to central liquifaction |
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** The last stage is indistinguishable from other [[Brain abscess|brain abscesses]] but has low bacillary burden |
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* In the CNS, may rupture and cause [[tuberculous meningitis]] |
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=== Epidemiology === |
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==Clinical Manifestations== |
==Clinical Manifestations== |
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=== Cerebral Tuberculoma === |
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* Often asymptomatic |
* Often asymptomatic |
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*Most commonly presents in conjunction with [[tuberculous meningitis]], though can present alone |
*Most commonly presents in conjunction with [[tuberculous meningitis]], though can present alone |
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* In CNS, may present with headache, seizures, or focal neurological deficits |
* In CNS, may present with headache, seizures, or focal neurological deficits |
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*There are numerous case reports of intracranial tuberculomas developing while on therapy[[CiteRef::nicolls2005in]] |
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=== Pulmonary Tuberculoma === |
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* Typically asymptomatic, developing at the site of initial disease |
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* Usually static, but can cavitate and spread new disease |
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=== Other Sites === |
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* Also case reports of tuberculomas in liver, heart, peripheral nerve, spine |
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==Differential Diagnosis== |
==Differential Diagnosis== |
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Latest revision as of 19:40, 13 June 2023
Background
Pathophysiology
- Collection of granulomatous tissue that results from hematogenous spread of Mycobacterium tuberculosis
- They are a granulomatous lesion of epithelioid cells and Langerhans giant cells surrounded by lymphocytes
- Progress from non-caseating to solid with central caseation to central liquifaction
- The last stage is indistinguishable from other brain abscesses but has low bacillary burden
- In the CNS, may rupture and cause tuberculous meningitis
Epidemiology
- Cerebral tuberculomas are more common in patients with HIV
Clinical Manifestations
Cerebral Tuberculoma
- Often asymptomatic
- Most commonly presents in conjunction with tuberculous meningitis, though can present alone
- In CNS, may present with headache, seizures, or focal neurological deficits
- There are numerous case reports of intracranial tuberculomas developing while on therapy1
Pulmonary Tuberculoma
- Typically asymptomatic, developing at the site of initial disease
- Usually static, but can cavitate and spread new disease
Other Sites
- Also case reports of tuberculomas in liver, heart, peripheral nerve, spine
Differential Diagnosis
Diagnosis
- Based on imaging, with ring-enhancing lesion with surrounding edema
- If there is uncertainty about the diagnosis, may need biopsy
Management
- Manage per primary diagnosis, with at least 6 months of standard therapy
- Dexamethasone can be considered for CNS tuberculoma with surrounding vasogenic edema and neurologic symptoms
References
- ^ Deborah J Nicolls, Mark King, David Holland, Jennifer Bala, Carlos del Rio. Intracranial tuberculomas developing while on therapy for pulmonary tuberculosis. The Lancet Infectious Diseases. 2005;5(12):795-801. doi:10.1016/s1473-3099(05)70299-1.
