Tuberculosis: When the key is the brain

Abstract is not required for Clinical Imagesis not required for Clinical Images (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 7 No. 1, January 2016. ISSN – [0976-3198] Int J Case Rep Images 2016;7(1):72–74. www.ijcasereportsandimages.com Cochicho et al. 72 CASE REPORT OPEN ACCESS Tuberculosis: When the key is the brain Joana Cochicho, Emília Louro, Armando Carvalho

neither by culture or nucleic acid amplification (NAA), it was decided to start the patient on multiple drug therapy for tuberculosis (isoniazid, rifampicin, pyrazinamide, and ethambutol), with improvement.

DISCUSSION
Despite the decreasing prevalence and mortality of tuberculosis, it is still a non-negligible problem across the globe and the second most deadly infectious agent in the world [1]. Extra pulmonary tuberculosis may have an indolent course and clinical manifestations vary considerably depending on the location, even when central nervous system is affected [2]. The gold standard for the diagnosis of Mycobacterium tuberculosis infection is culture identification. However, in extra-pulmonary tuberculosis its sensitivity ranges between 0-80%. Other methods, such as smear microscopy, NAA tests and IGRAs also have high variability [3]. Although IGRA assays have shown good results in the diagnosis of active tuberculosis in Bacillus Calmette-Guérin vaccinated populations, factors associated with negative results (such as age > 50 and male gender) have been identified and should be taken into account [4].

CONCLUSION
This report illustrates that the diagnosis of tuberculosis remains a challenge, not only because of its silent course but also due to the suboptimal diagnostic tests available. Although there was no identification of Mycobacterium tuberculosis in our patient, the exclusion of a more probable diagnosis and the risk of not treating a tuberculoma, led to the decision to start tuberculosis treatment.

Edorium Journals: An introduction
Edorium Journals Team

But why should you publish with Edorium Journals?
In less than 10 words -we give you what no one does.

Vision of being the best
We have the vision of making our journals the best and the most authoritative journals in their respective specialties. We are working towards this goal every day of every week of every month of every year.

Exceptional services
We care for you, your work and your time. Our efficient, personalized and courteous services are a testimony to this.

Editorial Review
All manuscripts submitted to Edorium Journals undergo pre-processing review, first editorial review, peer review, second editorial review and finally third editorial review.

Peer Review
All manuscripts submitted to Edorium Journals undergo anonymous, double-blind, external peer review.

Early View version
Early View version of your manuscript will be published in the journal within 72 hours of final acceptance.

Manuscript status
From submission to publication of your article you will get regular updates (minimum six times) about status of your manuscripts directly in your email.

Most Favored Author program
Join this program and publish any number of articles free of charge for one to five years.

Favored Author program
One email is all it takes to become our favored author. You will not only get fee waivers but also get information and insights about scholarly publishing.

Institutional Membership program
Join our Institutional Memberships program and help scholars from your institute make their research accessible to all and save thousands of dollars in fees make their research accessible to all.

Our presence
We have some of the best designed publication formats. Our websites are very user friendly and enable you to do your work very easily with no hassle.
We request you to have a look at our website to know more about us and our services.
We welcome you to interact with us, share with us, join us and of course publish with us.

Invitation for article submission
We sincerely invite you to submit your valuable research for publication to Edorium Journals.

Six weeks
You will get first decision on your manuscript within six weeks (42 days) of submission. If we fail to honor this by even one day, we will publish your manuscript free of charge.

Four weeks
After we receive page proofs, your manuscript will be published in the journal within four weeks (31 days). If we fail to honor this by even one day, we will publish your manuscript free of charge and refund you the full article publication charges you paid for your manuscript.