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Pelvic and central nervous system tuberculosis complicated by a paradoxical response manifesting as a spinal tuberculoma: a case report.
BMC Infect Dis. 2022 Sep 24; 22(1):750.BI

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 anti-tubercular 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.

Authors+Show Affiliations

Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. arya-zandvakili@uiowa.edu.Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

36153478

Citation

Zandvakili, Arya, et al. "Pelvic and Central Nervous System Tuberculosis Complicated By a Paradoxical Response Manifesting as a Spinal Tuberculoma: a Case Report." BMC Infectious Diseases, vol. 22, no. 1, 2022, p. 750.
Zandvakili A, Kobayashi T, Kaewpoowat Q, et al. Pelvic and central nervous system tuberculosis complicated by a paradoxical response manifesting as a spinal tuberculoma: a case report. BMC Infect Dis. 2022;22(1):750.
Zandvakili, A., Kobayashi, T., Kaewpoowat, Q., Parsons, M. G., Ford, B., Barker, J. H., & Johnson, M. (2022). Pelvic and central nervous system tuberculosis complicated by a paradoxical response manifesting as a spinal tuberculoma: a case report. BMC Infectious Diseases, 22(1), 750. https://doi.org/10.1186/s12879-022-07731-6
Zandvakili A, et al. Pelvic and Central Nervous System Tuberculosis Complicated By a Paradoxical Response Manifesting as a Spinal Tuberculoma: a Case Report. BMC Infect Dis. 2022 Sep 24;22(1):750. PubMed PMID: 36153478.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pelvic and central nervous system tuberculosis complicated by a paradoxical response manifesting as a spinal tuberculoma: a case report. AU - Zandvakili,Arya, AU - Kobayashi,Takaaki, AU - Kaewpoowat,Quanhathai, AU - Parsons,Meredith G, AU - Ford,Bradley, AU - Barker,Jason H, AU - Johnson,Melinda, Y1 - 2022/09/24/ PY - 2022/04/11/received PY - 2022/09/14/accepted PY - 2022/9/24/entrez PY - 2022/9/25/pubmed PY - 2022/9/28/medline KW - Disseminated tuberculosis KW - Paradoxical reaction KW - Post-partum tuberculosis KW - Spinal tuberculoma KW - Tuberculosis meningitis SP - 750 EP - 750 JF - BMC infectious diseases JO - BMC Infect Dis VL - 22 IS - 1 N2 - 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 anti-tubercular 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. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/36153478/Pelvic_and_central_nervous_system_tuberculosis_complicated_by_a_paradoxical_response_manifesting_as_a_spinal_tuberculoma:_a_case_report_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-022-07731-6 DB - PRIME DP - Unbound Medicine ER -