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Unusual association of diseases/symptoms
CASE REPORT
Cerebral tuberculomas in a 6-year-old girl causing central diabetes insipidus
  1. Shavindra Chellen1,
  2. Elizabeth Whittaker2,3,
  3. Michael Eisenhut4,
  4. Louis Grandjean2
  1. 1Paediatric Speciality Trainee, Imperial College Healthcare NHS Trust, London, London, UK
  2. 2Consultant Paediatric Infectious Diseases and Immunology, Imperial College Healthcare NHS Trust, St Mary’s Hospital, London, UK
  3. 3Department of Academic Paediatrics, Imperial College, London, UK
  4. 4Consultant Paediatrician, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
  1. Correspondence to Dr Shavindra Chellen, schellen{at}nhs.net

Summary

A 6-year-old girl presented acutely with worsening frontal headaches. She had a 3-month history of lethargy, reduced appetite, weight loss, cough and intermittent fevers. A chest X-ray showed a left upper lobe consolidation, and a CT head showed multiple enhancing lesions with significant surrounding oedema in both cerebral hemispheres. Due to the strong suspicion of tuberculosis (TB), she was admitted and treated with anti-TB therapy and steroids. Following this, pulmonary infection with Mycobacterium tuberculosis was confirmed by a positive PCR from induced sputum. Cerebral spinal fluid (CSF) analysis was normal and tested negative for M. tuberculosis on PCR. During her first week of treatment, she developed polyuria, nocturia and polydipsia and was diagnosed with central diabetes insipidus. She was started on desmopressin which rapidly improved her symptoms, and she was continued on desmopressin for 3 months. Currently, she remains well and has shown a good response to TB treatment.

  • paediatrics
  • tb and other respiratory infections
  • pituitary disorders

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bcr-2018-226590

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    Footnotes

    • Contributors The corresponding author, SC, was responsible for drafting this article. EW, LG and ME were responsible for critical revisions of the article. ME, EW, LG and SC were all involved in the care of this patient. ME obtained consent. EW supervised the overall process.

    • Funding EW is funded by a Wellcome Trust Global Health Research Seed Grant PS3167

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.