Unusual clinical course, Unusual setting of medical care
Killen H. Briones-Claudett, Mónica H. Briones-Claudett, Killen H. Briones Zamora, Rubén D. Nieves Velez, Marlon E. Martinez Alvarez, Michelle Grunauer Andrade
Faculty of Medical Sciences, Universidad de Guayaquil, Guayaquil, Ecuador
Am J Case Rep 2020; 21:e920410
Available online: 2020-04-14
Tuberculosis (TB) continues to be a major public health problem worldwide. Extrapulmonary tuberculosis at the level of the central nervous system is the most devastating and deadly form of tuberculosis.
CASE REPORT: We present the case of a 73-year-old male Ecuadorian patient with no history of contact with tuberculosis and with a clinical picture of 4 days of evolution characterized by aphasia, deviation of the labial commissure, and deterioration of the level of consciousness with a Glasgow coma score of 7/15. A brain tomography showed evidence of indirect signs of cerebral ischemia; the patient was therefore diagnosed with non-specific cerebrovascular disease. Due to the critical nature of his clinical picture, the patient entered the Intensive Care Unit (ICU), where a chest x-ray was performed and bilateral perihilar alveolar opacities with a reticular and nodular pattern were visualized. These results, combined with the bronchoalveolar brushing, evidenced the presence of Mycobacterium tuberculosis. Adenosine of deaminase (ADA) was also detected in the cerebrospinal fluid with 30.7 µ/L and a molecular biology technique was used with high-multiplex real-time polymerase matrix MALDI-TOF mass spectrometry (Brucker Daltonics) for rapid identification of the causative agent. DNA/polymerase chain reaction (PCR) analyses were used for detection of M. tuberculosis, subsequently confirming the presence of cerebral tuberculosis.
CONCLUSIONS: This case illustrated an infrequent form of disseminated tuberculosis in a critically ill patient. Timely diagnosis and appropriate management are essential to reducing mortality.
Keywords: brain infarction, Glasgow Coma Scale, Intensive Care Units, Mycobacterium Infections, Nontuberculous, Stroke