외상으로 오인될 수 있는 두개골 천공을 동반한 결핵성 수막뇌염: 부검 1예 보고
Tuberculous Meningoencephalitis with Skull Perforation Possibly Mistaken for Trauma: An Autopsy Case Report
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Although tuberculosis can affect various parts of the central nervous system, tuberculous meningitis is the most lethal form. Tuberculous meningoencephalitis and cranial tuberculosis are extremely rare. Therefore, the authors present an autopsy case of tuberculous meningoencephalitis resulting in skull perforation. This condition can be mistaken for trauma, which may cause forensic confusion. A 45-year-old woman died at home. External examination revealed an unhealed open wound on the left side of the occiput. The scalp incision revealed extensive congestion, purulent exudate, and an irregular perforation in the corresponding skull area. When the skull was opened, adhesion of the dura mater to the skull was found, accompanied by purulent inflammation. Cerebral edema and hydrocephalus were present, with necrosis in the upper part of the right basal ganglia. Pathological examination identified purulent and chronic granulomatous inflammation in the dura and brain parenchyma, with a few acid-fast bacilli detected. Additionally, an adenosquamous carcinoma measuring approximately 2.5×2 cm was found in the left upper lobe of the lung. This case highlights the importance of a thorough legal autopsy to accurately determine the cause of death, as the inflammatory changes in the scalp could be misinterpreted as trauma from a forensic perspective.
Abstract
Although tuberculosis can affect various parts of the central nervous system, tuberculous meningitis is the most lethal form. Tuberculous meningoencephalitis and cranial tuberculosis are extremely rare. Therefore, the authors present an autopsy case of tuberculous meningoencephalitis resulting in skull perforation. This condition can be mistaken for trauma, which may cause forensic confusion. A 45-year-old woman died at home. External examination revealed an unhealed open wound on the left side of the occiput. The scalp incision revealed extensive congestion, purulent exudate, and an irregular perforation in the corresponding skull area. When the skull was opened, adhesion of the dura mater to the skull was found, accompanied by purulent inflammation. Cerebral edema and hydrocephalus were present, with necrosis in the upper part of the right basal ganglia. Pathological examination identified purulent and chronic granulomatous inflammation in the dura and brain parenchyma, with a few acid-fast bacilli detected. Additionally, an adenosquamous carcinoma measuring approximately 2.5×2 cm was found in the left upper lobe of the lung. This case highlights the importance of a thorough legal autopsy to accurately determine the cause of death, as the inflammatory changes in the scalp could be misinterpreted as trauma from a forensic perspective.
참고문헌 (16)
- Global tuberculosis report 2023, "World Health Organization", World Health Organization, ~ (2023)
- Wilkinson RJ, "Tuberculous meningitis", Nat Rev Neurol, 13, pp.581~598 (2017)
- Schaller MA, "Central nervous system tuberculosis : etiology, clinical manifestations and neuroradiological features", Clin Neuroradiol, 29, pp.3~18 (2019)
- Dian S, "Central nervous system tuberculosis", Curr Opin Neurol, 34, pp.396~402 (2021)
- Sharma R, "Tuberculosis of the skull : a case report and review of the literature", Neurosurg Rev, 23, pp.104~106 (2000)
- Mohanty S, "Tuberculosis of the skull", Int Surg, 66, pp.81~83 (1981)
- Jadhav RN, "Calvarial tuberculosis", Neurosurgery, 45, pp.1345~1349 (1999)
- R R, "Tuberculous skull base osteomyelitis with cerebral venous sinus thrombosis in an immunocompetent adolescent : a case report", Cureus, 14, pp.e23865~ (2022)
- Diyora B, "Calvarial tuberculosis : a report of eleven patients", Neurol India, 57, pp.607~612 (2009)
- Bhoi SK, "Skull base and calvarial tuberculosis presenting as chronic meningitis", Indian J Tuberc, 67, pp.411~413 (2020)
- Kicherova OA, "A case of tuberculous meningoencephalomyelitis", Zh Nevrol Psikhiatr Im S S Korsakova, 122, pp.135~143 (2022)
- Kolbinger R, "Tuberculous meningoencephalitis with primary destruction of the cranial base and secondary development of multiple tuberculomas", Nervenarzt, 65, pp.132~135 (1994)
- Vinnard C, "Tuberculous meningitis in HIV-infected individuals", Curr HIV, 2009, pp.6, 139~145
- Kamboj M, "The risk of tuberculosis in patients with cancer", Clin Infect Dis, 42, pp.1592~1595 (2006)
- Nanthanangkul S, "Incidence of and risk factors for tuberculosis among cancer patients in endemic area : a regional cohort study", Asian Pac J Cancer Prev, 21, pp.2715~2721 (2020)
- Davis AG, "The pathogenesis of tuberculous meningitis", J Leukoc Biol, 105, pp.267~280 (2019)