Journal article
Pelvic and central nervous system tuberculosis complicated by a paradoxical response manifesting as a spinal tuberculoma: a case report
BMC infectious diseases, Vol.22(1), pp.1-750
09/24/2022
DOI: 10.1186/s12879-022-07731-6
PMCID: PMC9509540
PMID: 36153478
Abstract
Background: The post-partum period is a risk factor for tuberculosis (TB), possibly including the period after miscarriage as illustrated here. This case demonstrates how non-specific symptoms can hide widely disseminated TB.
Case presentation: A healthy 26-year-old female with a history of recent miscarriage presented to the emergency department with non-specific symptoms of headache, abdominal pain, and sub-acute fevers. She had immigrated to the United States from the Marshall Islands 9 years prior. Two months prior to presentation she had a miscarriage at 18 weeks of pregnancy. On admission, transvaginal ultrasound revealed retained products of conception and abdominal computed tomography revealed findings consistent with tubo-ovarian abscesses and peritonitis. The obstetrics and gynecology service performed dilation and curettage (D&C) to remove retained products of conception. Acid-fast bacilli cultures from cerebrospinal fluid as well as specimens from D&C and intra-abdominal abscesses subsequently all grew TB. She was diagnosed with TB meningitis, peritonitis, endometritis, and tubo-ovarian abscesses. Her treatment course was complicated by a paradoxical response resulting in a spinal tuberculoma causing lower extremity weakness. The tuberculoma was treated with surgical decompression as well as continuation of treatment with antitubercular chemotherapy and steroids.
Conclusion: Disseminated and extrapulmonary TB can present with non-specific symptoms. Recognition of risk factors for TB is critical for prompt diagnostic evaluation and treatment of this deadly disease. A paradoxical reaction needs to be taken into consideration when any new neurological symptoms occur during TB treatment.
Details
- Title: Subtitle
- Pelvic and central nervous system tuberculosis complicated by a paradoxical response manifesting as a spinal tuberculoma: a case report
- Creators
- Arya Zandvakili - University of Iowa Hospitals and ClinicsTakaaki Kobayashi - Univ Iowa Hosp & Clin, Dept Internal Med, Div Infect Dis, Iowa City, IA 52242 USAQuanhathai Kaewpoowat - University of IowaMeredith G. Parsons - University of IowaBradley Ford - Univ Iowa Hosp & Clin, Dept Pathol, Iowa City, IA 52242 USAJason H. Barker - Univ Iowa Hosp & Clin, Dept Internal Med, Div Infect Dis, Iowa City, IA 52242 USAMelinda Johnson - Univ Iowa Hosp & Clin, Dept Internal Med, Div Gen Internal Med, Iowa City, IA 52242 USA
- Resource Type
- Journal article
- Publication Details
- BMC infectious diseases, Vol.22(1), pp.1-750
- DOI
- 10.1186/s12879-022-07731-6
- PMID
- 36153478
- PMCID
- PMC9509540
- NLM abbreviation
- BMC Infect Dis
- ISSN
- 1471-2334
- eISSN
- 1471-2334
- Publisher
- Springer Nature
- Number of pages
- 7
- Language
- English
- Date published
- 09/24/2022
- Academic Unit
- Infectious Diseases; Pathology; Internal Medicine
- Record Identifier
- 9984359953502771
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