Left temporal epilepsy unmasking tuberculoma in an immunocompetent adolescent: Case report

Q4 Medicine Atencion Primaria Practica Pub Date : 2024-04-01 DOI:10.1016/j.appr.2024.100198

Abdirahman Ibrahim Said , Mohamoud Abdulahi , Abdirahman Omer Ali , Asma Mohamoud Koshin , Said Ahmed Walhad , Abdisalam Hassan Muse

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Abstract

Tuberculosis (TB) is a chronic granulomatous disease caused by Mycobacterium tuberculosis, with extrapulmonary manifestations occurring in approximately 1% of cases. Among these, central nervous system involvement, including intracranial tuberculomas, is rare. We present the case of a 13-year-old female from Borama, Somalia, admitted with abnormal lip movements and a complex medical history, including weight loss, recurrent urinary tract infections, and a familial predisposition to TB. Neurological examination revealed left-sided facial deviation and hyperreflexia, prompting investigations that confirmed left temporal epilepsy and a right-sided tuberculoma. Treatment with levetiracetam and anti-TB medication led to significant improvement. This case underscores the importance of considering tuberculomas in the differential diagnosis of neurological presentations, even in non-HIV patients, especially in resource-limited settings like Africa.

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免疫功能正常的青少年左颞部癫痫掩盖了结核瘤：病例报告

结核病（TB）是由结核分枝杆菌引起的一种慢性肉芽肿性疾病，约有 1%的病例会出现肺外表现。其中，中枢神经系统受累（包括颅内结核瘤）的病例很少见。本病例是一名来自索马里博拉马的 13 岁女性，入院时嘴唇活动异常，病史复杂，包括体重减轻、反复尿路感染和家族性结核病倾向。神经系统检查发现她有左侧面部偏斜和反射亢进，检查结果证实她患有左侧颞叶癫痫和右侧结核瘤。使用左乙拉西坦和抗结核药物治疗后，病情明显好转。该病例强调了在神经系统疾病的鉴别诊断中考虑结核瘤的重要性，即使是非艾滋病毒感染者也不例外，尤其是在非洲等资源有限的地区。

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