Rare presentation of tuberculous hypertrophic pachymeningitis diagnosed by a biopsy of abdominal lymphadenopathy

• Published in: SAGE open medical case reports Vol. 10; p. 2050313X221085866
• Main Authors: Yoshida, Makiko, Ishizuka, Naoki, Mizuno, Masanori, Maeta, Manami, Maeda, Tetsuya
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.03.2022; Sage Publications Ltd; SAGE Publishing
• Subjects: Case Report; Case reports; Lymphatic system; Tuberculosis; Tuberculous hypertrophic pachymeningitis; abdominal paraaortic lymphadenopathy; tuberculous lymphadenopathy
• ISSN: 2050-313X; 2050-313X
• DOI: 10.1177/2050313X221085866

A 59-year-old man with medical history of diabetes mellitus and hypertension presented with a persistent fever of unknown origin and developed a headache. Laboratory tests, including polymerase chain reaction assays for Mycobacterium tuberculosis, showed no specific abnormal findings in blood or cerebrospinal fluid. Contrast-enhanced computed tomography revealed abdominal paraaortic lymphadenopathy. Abdominal lymph node biopsy showed caseous necrosis and suggested tuberculous lymphadenopathy. Intensive examinations revealed positive T-SPOT.TB test and multiple dural nodular hypertrophic lesions in brain magnetic resonance imaging. After antitubercular treatment, all clinical manifestations and dural nodular lesions improved. Finally, we diagnosed the patient with tuberculous hypertrophic pachymeningitis. To our knowledge, this is the first report of tuberculous hypertrophic pachymeningitis concomitant with abdominal tuberculous lymphadenopathy and no other dissemination. Systematic investigation of tuberculosis is important for pachymeningitis.