CEREBRAL AND PULMONARY MILIARY TUBERCULOS IS IN AN IMMUNOCOMPETENT PATIENT ADEQUATELY TREATED

BACKGROUND: Extrapulmonary localizations are observed in 20% of tuberc ulosis cases, mainly in immunosuppressed patients. Prognosis is poor i n case of relatively uncommon cerebral localizations and miliary disse mination, especially ii treatment is initiated in late stages. We repo rt a case of disseminated tuberculosis associated with cerebral and pu lmonary localizations in an immunocompetent patient. THe disease progr essed despite adapted treatment. CASE REPORT: A young immunocompetent man with an uneventful history developed miliary tuberculosis with pul monary localizations visualized on the computed tomography (CT) of the thorax. Brain CT was normal, but magnetic resonance imaging revealed several intracranial lesions. The disease course was marked by develop ment of neurological symptoms and progression of the cerebral lesions after one month of treatment. No evidence of therapeutic failure (insu fficient dosing, non-compliance, primary resistance) could be identifi ed. DISCUSSION: Magnetic resonance imaging provides a more precise eva luation of tuberculosis lesions in the brain. Early antituberculosis t herapy associated with corticosteroids can improve prognosis. Clinicia ns should be aware that cerebral lesions may continue to progress desp ite appropriate treatment, a course which is not satisfactorily explai ned by any current pathogenic hypothesis. (C) 1998, Masson, Paris.