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Título

DISSEMINATED TUBERCULOSIS IN A THREE MONTH OLD INFANT: EFFECTS ON THE CENTRAL NERVOUS SYSTEM

Apresentação do caso

Case: 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.

Discussão

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.

Comentários finais

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.

Referências (se houver)

1. Basu Roy R, Whittaker E, Seddon JA, Kampmann B. Tuberculosis susceptibility and protection in children. Lancet Infect Dis. 2019;19(3):e96-e108. Epub 2018/10/17.
2. Lule SA, Mawa PA, Nkurunungi G, Nampijja M, Kizito D, Akello F, et al. Factors associated with tuberculosis infection, and with anti-mycobacterial immune responses, among five year olds BCG-immunised at birth in Entebbe, Uganda. Vaccine. 2015;33(6):796-804. Epub 2014/12/23.
3. Banga S, Azad C, Gupta R, Sawal N, Mahajan V, Chander J, et al. Changing Clinicoradiologic Spectrum of Intracranial Neurotuberculosis in Children: A Cross-sectional Study. J Child Neurol. 2020;35(13):879-88. Epub 2020/07/18.
4. Fatema K, Rahman MM, Akhter S, Akter N, Paul BC, Begum S, et al. Clinicoradiologic Profile and Outcome of Children With Tubercular Meningitis in a Tertiary Care Hospital in Bangladesh. J Child Neurol. 2020;35(3):195-201. Epub 2019/11/16.

Fonte de Fomento (se houver)

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Área

Neuroinfecções