Tuberc Respir Dis.  2009 Jun;66(6):457-462.

A Case Report of Tuberculous Brain Abscess and Tuberculous Peritonitis Developing Due to Paradoxical Reactions

• Ahn TH
• Park MB
• Lee KJ
• Jung EH
• Kim JW
• Suh SY
• Kang SW
• Kim EN
• Han YJ
• Cho SK

Abstract

While receiving appropriate treatment, patients with tuberculosis occasionally have unusual, paradoxical reactions, with transient worsening of lesions or the development of new lesions. This report is a case of tuberculosis brain abscess and tuberculosis peritonitis with intra-abdominal abscess that developed during appropriate anti-tuberculosis chemotherapy. A 45-year-old male patient had been diagnosed as with all-drug susceptible pulmonary tuberculosis with pleurisy. Subsequently, the patient underwent standard treatment with anti-tuberculosis therapy; the pulmonary lesions improved. Three months after initial treatment, the patient developed brain abscesses and peritonitis. With the addition of corticosteroid treatment, the patient's neurologic symptoms were relieved. Exploratory laparotomy with surgical drainage was performed and a diagnosis of tuberculosis peritonitis was confirmed on biopsy. Anti-tuberculosis therapy was continued for 19 months, the patient improved eventually without further complications, although the therapeutic regimen had not been altered. In this case, the paradoxical response to treatment may have been involved in the pathogenesis of disease.

Keyword

Paradoxical response; Tuberculosis brain abscess; Tuberculosis peritonitis

MeSH Terms

Abdominal Abscess
Biopsy
Brain
Brain Abscess
Drainage
Humans
Laparotomy
Male
Middle Aged
Neurologic Manifestations
Peritonitis
Peritonitis, Tuberculous
Pleurisy
Tuberculosis
Tuberculosis, Pulmonary

Figure

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  Figure 1 (A) Chest X-ray at antituberculous chemotherapy initiation. Marked left pleural effusion was found. Loculated effusion on right upper lobe also noted. (B) Chest X-ray at 3 months after antituberculous chemotherapy. Left pleural effusion completely resolved. Loculated effusion on right upper lobe also disappeared.

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  Figure 2 (A) T1 enhance axial image of brain MR on admission day. Thick ring enhanced cystic lesion on left sylvian fissure area was detected. (B) T2 enhance coronal image of brain MR on admission day. Marked periregional edema with midline shifting also detected.

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  Figure 3 Contrast-enhanced abdomen computed tomography at admission 11 days later. Intra abdominal fluid collection with irregular peritoneal line was noted.

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  Figure 4 Contrast-enhanced brain computed tomography (CT) scanning of patient. (A) Brain CT at 9 months after treatment. Thin-walled low attenuation area on left temporoparietal lobe lesion was shown. Marked perilesional edema and midline shifting also noted. Newly developed lesion was not seen. (B) Brain CT at 13 months after treatment. Left temporoparietal abscess was mild decreased. Perilesional edema much decreased. (C) Brain CT at 17 months after treatment. Left temporoparietal abscess was considerably decreased. (D) Brain CT at 23 months after treatment. Abscess size and edema more decreased. (E) Brain CT at 32 months after treatment. Abscess size and edema much improved.

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