Disseminated tuberculosis in a three month old infant: effects on the central nervous system

Case presentation: A 3 month-old boy with fever and new episodes of seizures was admitted from another institution in an ongoing tuberculosis investigation substantiated by central nervous system imaging. The patient evolved with seizures recurrence and fluctuating consciousness. Ophthalmology exam revealed chorioretinitis. Neural axis abnormalities on magnetic resonance imaging were described with signs of diffuse meningoencephalitis complicated with vasculitis and subacute infarctions in the territories of the anterior cerebral arteries bilaterally and nucleocapsular, hemoventricle and subarachnoid hemorrhage. Moreover, a nodular lesion in the medullary transition to the left and tenuous diffuse enhancement of the cauda equina roots. These evidences were relevant to guide the initial therapeutic strategy, until the patient's clinical stability allowed additional diagnostic measures performed in our service.

Discussion: Young children are especially susceptible to tuberculosis and its severe forms when exposed to Mycobacterium tuberculosis. Disseminated form of this disease reverberates with high morbidity and mortality in individuals with immature immune responses¹. The infection and development of the disease is also related to the recurrence and intensity of exposure². The most prevalent alterations in neuroimaging are hydrocephalus, tubercular meningitis, infarcts and basal exudates; in addition, coexisting tuberculomas may be found³. In this case report, important lesions triggered seizures and consciousness oscillations. Neuroimaging findings corroborate diagnosis, help in timely therapeutic strategy and patient's outcome, especially in neurodevelopment perspective for this young children⁴.

Final comments: Disseminated tuberculosis is a threatening disease for children, especially with multiple neurological lesions that predicts unfavorable neurodevelopment. The mean of this case is to reinforce the importance of correlating clinical findings and timely complementary exams to guide the therapeutic choice and establish differential diagnosis.

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Publikationsverlauf

Artikel online veröffentlicht:
18. September 2023