Images in Intensive Medicine
Complications of tuberculous meningitis in magnetic resonance imaging in a patient with systemic lupus erythematosus
Complicaciones de meningitis tuberculosa en resonancia magnética en un paciente con lupus eritematoso sistémico
a Servicio de Medicina Interna, Hospital General «Dr. Manuel Gea González», Mexico City, Mexico
b Servicio de Imagenología Diagnóstica y Terapéutica, Hospital General «Dr. Manuel Gea González», Mexico City, Mexico
c Servicio de Neurología, Hospital General «Dr. Manuel Gea González», Mexico City, Mexico
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The patient was HIV-negative, and cerebrospinal fluid analysis revealed a clear appearance, hypoglycorrachia (58<span class="elsevierStyleHsp" style=""></span>mg/dl), proteins 120<span class="elsevierStyleHsp" style=""></span>mg/dl, pleocytosis 600 cells/μl (monocytes 39% and polymorphonuclear cells 61%), black ink negativity, negative cultures and GeneXpert® System (Cepheid, Sunnyvale, USA) positivity in cerebrospinal fluid for DNA of <span class="elsevierStyleItalic">M. tuberculosis</span>. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows a magnetic resonance imaging view of the brain in transverse and coronal section, with intense enhancement in the basal ganglia and at meningeal and leptomeningeal level (arrowheads) of both frontal lobes and the left temporal lobe, as well as reduction and erasure of the sulci and fissures, related to edema consistent with cerebritis (white arrows). The right cingular circumvolution and ipsilateral parietal lobe presented an abscess measuring 18<span class="elsevierStyleHsp" style=""></span>mm in size, with ring-form enhanced uptake of the contrast medium (curved arrows). Treatment was started with antituberculous agents and dexamethasone as adjuvant, but proved ineffective, and the patient died two weeks after the diagnosis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0010" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:2 [ "identificador" => "xack455775" "titulo" => "Acknowledgements" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Márquez-Villegas FG, Elizalde-Figueroa A, Venzor-Castellanos JP. Complicaciones de meningitis tuberculosa en resonancia magnética en un paciente con lupus eritematoso sistémico. Med Intensiva. 2020;44:204–205.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1249 "Ancho" => 2093 "Tamanyo" => 370632 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Magnetic resonance imaging view of the brain in transverse and coronal section.</p>" ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack455775" "titulo" => "Acknowledgements" "texto" => "<p id="par0015" class="elsevierStylePara elsevierViewall">Thanks are due to Hospital General «Dr. Manuel Gea González» for our resident training in the specialty.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004400000003/v1_202003270001/S2173572719302413/v1_202003270001/en/main.assets" "Apartado" => array:4 [ "identificador" => "64602" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Intensive Medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004400000003/v1_202003270001/S2173572719302413/v1_202003270001/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719302413?idApp=WMIE" ]
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