1 - Unidade de Infeciologia, Área de Pediatria Médica, Hospital Dona Estefânia, Unidade Local de Saúde de São José, Centro Clínico Académico de Lisboa, Portugal
2 - Unidade de Neuroradiologia, Hospital Dona Estefânia, Unidade Local de Saúde de São José, Centro Clínico Académico de Lisboa, Portugal
3 - Unidade de Neurologia, Área de Pediatria Médica, Hospital Dona Estefânia, Unidade Local de Saúde de São José, Centro Clínico Académico de Lisboa, Portugal
- Póster, ESPID 2024
Resumo:
Background: Brain tuberculoma is a rare and severe manifestation of extrapulmonary tuberculosis (TB), involving granulomatous brain lesions that can remain asymptomatic and rapidly progress, with a high risk of mortality.
Case presentation: We describe a 6-year-old boy with HIV on antiretroviral treatment (ABC + 3TC + DTG) for an unknown period (with a viral load of < 50.0 copies/mL and a CD4 count of 1049). He was born in Guinea-Bissau and evacuated to Portugal for a suspected left knee tumor. He presented with persistent pain, tumefaction, limited motion for three years, weight loss, mucosal paleness, no cough. Neurologic examination was normal. Interferon-Gamma Release Assay (IGRA) was positive, and chest X-ray revealed superior mediastinum widening. Imaging studies revealed thoracic and abdominal lymph node involvement, evidence of miliary dissemination throughout both the right and left femur, chronic synovitis of the left knee with epiphyses hypertrophy, suggestive of tuberculous arthritis. Drug-susceptible Mycobacterium tuberculosis was identified in bronchoalveolar Lavage (BAL). Spinal MRI showed suspicious lesions in the left middle cerebelar peduncle. For better characterization of the lesion, cranial MRI was performed, showing multiple brain lesions, nodular, intra-axial, with signal characteristics, ring enhancement post-contrast, indicative of widespread tuberculomas in the brain, while lumbar puncture results were normal. The patient was discharged with a diagnosis of HIV infection meeting clinical criteria for AIDS due to disseminated TB along with the incidental finding of tuberculomas on MRI that did not exhibit apparent clinical symptoms.
Conclusion: Early detection is critical for asymptomatic brain tuberculomas to prevent severe neurological complications. Despite their rarity, considering tuberculomas in the differential diagnosis of cerebral lesions in pediatric HIV patients with unknown duration is important for timely intervention.