24 May 2018 : Case report
Role of Immuno-Polymerase Chain Reaction (I-PCR) in Resolving Diagnostic Dilemma Between Tuberculoma and Neurocysticercosis: A Case Report
Unusual clinical course, Challenging differential diagnosis
Sonia Ahlawat12ABCDEF, Surekha Dabla3ABDEF, Vinay Kumar4ABCDF, Machiavelli Singh2ACDEF, Kiran Bala3ABCDEF*, Promod K. Mehta1ABCDEFGDOI: 10.12659/AJCR.908624
Am J Case Rep 2018; 19:599-603
Abstract
BACKGROUND: Tuberculoma and neurocysticercosis (NCC) often show similar clinical and neuroimaging features. Differential diagnosis of these 2 diseases is imperative, as tuberculoma is an active infection that requires immediate anti-tubercular therapy (ATT).
CASE REPORT: We present the case of a 17-year-old Indian girl with fever, severe headache, and right 6th cranial nerve palsy. Brain magnetic resonance imaging (MRI) showed multiple tiny ring-enhancing lesions in bilateral cerebral parenchyma with mild perilesional edema, which were initially thought to be NCC, but subsequently were diagnosed as brain tuberculomas. Based on clinical findings, mildly increased choline/creatine ratio (1.35) with slight prominent lipid lactate peak and absence of alanine, succinate peak by magnetic resonance spectroscopy (MRS), and the detection of Mycobacterium tuberculosis (Mtb)-specific early-secreted antigenic target-6 (ESAT-6, Rv3875) protein from the cerebrospinal fluid (CSF) by indirect ELISA, as well as indirect immuno-PCR (I-PCR) assay, diagnosis of brain tuberculomas associated with tuberculous meningitis (TBM) was confirmed, which was followed by ATT. The patient responded well and the symptoms resolved.
CONCLUSIONS: In this case, multiple ring-enhancing lesions of the brain by MRI were diagnosed as tuberculomas associated with TBM by MRS and indirect ELISA/I-PCR method, thus resolving the diagnostic dilemma.
Keywords: Immuno-Polymerase Chain Reaction, Neurocysticercosis, tuberculoma
In Press
17 Mar 2024 : Case report
Rare Presentation of Rapidly Involuting Congenital Hemangioma of the Skull: A Case ReportAm J Case Rep In Press; DOI: 10.12659/AJCR.943370
18 Mar 2024 : Case report
Perineal Benign Symmetric Lipomatosis in a Female Patient: A Case ReportAm J Case Rep In Press; DOI: 10.12659/AJCR.943803
18 Mar 2024 : Case report
Successful Endovascular Microembolization for Post-Traumatic High-Flow Priapism: A Case ReportAm J Case Rep In Press; DOI: 10.12659/AJCR.943467
19 Mar 2024 : Case report
Jejunal Diverticulosis Causing Small Intestinal Volvulus and Closed Loop ObstructionAm J Case Rep In Press; DOI: 10.12659/AJCR.943376
Most Viewed Current Articles
07 Mar 2024 : Case report
Neurocysticercosis Presenting as Migraine in the United StatesDOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
10 Jan 2022 : Case report
A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...DOI :10.12659/AJCR.935263
Am J Case Rep 2022; 23:e935263
19 Jul 2022 : Case report
Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19DOI :10.12659/AJCR.936128
Am J Case Rep 2022; 23:e936128
23 Feb 2022 : Case report
Penile Necrosis Associated with Local Intravenous Injection of CocaineDOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250