PMC9235427_01
A 1-year-7-months-old infant with multiple organ tuberculomas who presented with shortness of breath, lumps in the neck and weakness on in both legs and right hand. (A-C) Brain window axial, coronal and sagittal view of nonenhanced head CT showed isodense lesion at pons (black arrow) with peripheral edema. (D-E) There was also another lesion with the same density (white arrow) at right caudate nuclei and (F) left thalamus. (D-F) There was finger-like edema at bilateral parietooccipital lobe (head arrows) with unclear mass density in it and widening of bilateral coronaria suture (not shown).
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F1
There was weakness in both legs and right hand for the past 4 months and a nonenhanced head CT from a previous hospital revealed multiple masses in the pons, right basal ganglia and left thalamus; bilateral temporoparietooccipital vasogenic edema with bilateral coronary suture diastasis (sign of increased intracranial pressure) [Figure 1].
A 1-year-7-months-old infant with multiple organ tuberculomas who presented with shortness of breath, lumps in the neck and weakness on in both legs and right hand. Anteroposterior projection of chest radiograph showed soft tissue density with unclear margin at left lung field (black arrow). There was also obscuration of the left costo-phrenicus angle.
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F2
The anteroposterior chest radiograph revealed mass density in the left lung field [Figure 2].
A 1-year-7-months-old infant with multiple organ tuberculomas who presented with shortness of breath, lumps in the neck and weakness on in both legs and right hand. (A-C) Mediastinal window in axial, coronal, and sagittal view of nonenhanced chest CT showed homogeneous mass with punctate calcification and air density inside, relatively well-defined, regular margins measuring +- 10.1 x 6.48 x 8.28 cm on inferior lobe of the left lung (black arrow) pushing the left superior lobe and left inferior lower bronchus of the lung left to the anterior and mediastinal organ to the contralateral. (D-F) There were also multiple lymphadenopathies at right paratrachea, subcarina dan right peribronchial (white arrows). Lung window in axial, coronal, and sagittal view of nonenhanced chest CT showed consolidation with air bronchogram sign inside the superior lobe and the medioposterobasal segment of the inferior lobe of the right lung (arrow heads).
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F3
According to these manifestations, the authors suspected the mass was giant tuberculoma accompanied by mediastinal lymphadenopathies and bacterial pneumonia [Figure 3].
A 1-year-7-months-old infant with multiple organ tuberculomas who presented with shortness of breath, lumps in the neck and weakness on in both legs and right hand. Cervical ultrasound showed (A) normal bilateral thyroid lobes and (B-C) multiple well demarcated, irregular edges, clustered hypoechoic lesions with coarse and peripheral calcification at both cervical region (white arrows) (level II, III, IV, and V).
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F4
Cervical ultrasound showed multiple calcified lymphadenopathies in both cervical regions [Figure 4].
A 1-year-7-months-old infant with multiple organ tuberculomas who presented with shortness of breath, lumps in the neck and weakness on in both legs and right hand. (A-H) Axial, coronal and sagittal view of brain MRI with contrast showed multiple isointense lesions on T1 with peripheral rim enhancement post contrast, hypointense with slightly hyperintense edges on T2 well-defined, regular surface with perifocal edema in the midbrain (white arrow), right occipital lobe (yellow arrow), and right caudate nucleus (blue arrow) with the largest size +- 2.51 x 2.65 x 2.57 cm. There was also focal enhancement of the sulci and gyri of bilateral occipital region with extensive white matter edema of the bilateral parietotemporooccipital lobes (red arrow), especially the right side. (I) MR Spectrometry showed high lipid-lactate peak.
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F5
Brain MRI with contrast showed multiple lesions in the midbrain, right occipital lobe, and right caudate nucleus suggesting tuberculoma, and focal leptomeningitis in the bilateral occipital region [Figure 5].
A 1-year-7-months-old infant with multiple organ tuberculomas who presented with shortness of breath, lumps in the neck and weakness on in both legs and right hand. Histopathological review of the lumps at cervical region, using hematoxylin and eosin (H&E stain) demonstrated (A) granuloma with lymphocytes at the edges (arrow), 20x magnification; (B, C) There were also epithelioid histiocytes (arrow) and Datia Langhans cells (arrow) between the granulomas, respectively. No central caseous necrotic mass formation was seen in this preparation, x40 magnification.
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F6
Histopathological review of the lumps concluded a chronic granulomatous lymphadenitis and supported a TB infection [Figure 6].