{"id":"7ee46128-6608-4d54-95a1-ae2e06f80d70","slug":"hypertrophic-cranial-pachymeningitis-coinfection-with-tuberculosis-and-actinomycosis","title":"Hypertrophic cranial pachymeningitis coinfection with tuberculosis and actinomycosis","authors":["Ali Akhaddar","Issam Rharrassi"],"abstract":"This is a rare case report about hypertrophic cranial pachymeningitis coinfection with tuberculosis and actinomycosis in a 35-year-old male. The patient presented with progressive headache, paraesthesia, and blurred vision. Dural biopsy, histology, and cultures are imperative in pachymeningitis for establishing the diagnosis and guiding treatment. A 35-year-old male presented with progressive headache, paraesthesia, and blurred vision. The MRI showed diffuse meningeal enhancement with thickening, along with areas of brain edema [ Figure 1a - c ]. Despite this mild meningeal inflammatory syndrome, cultures were negative. Although there was an initial perceived response to steroids, the patient had a relapse. A dural biopsy revealed epithelioid-giant cell granulomas with caseous necrosis, and TB- PCR of tissue was positive [ Figure 1d ]. In addition, the anaerobic culture (requiring about 4 weeks) eventually grew Actinomyces species. The patient had a good response to oral ciprofloxacin and antituberculous medication. The conclusion was that dural biopsy, histology, and cultures are imperative in pachymeningitis for establishing the diagnosis and guiding treatment. Axial (a), sagittal (b), and coronal (c) cranial magnetic resonance imaging following gadolinium injection showing diffuse meningeal enhancement and thickening, along with areas of brain edema. Dural biopsy revealing epithelioid-giant cell granulomas with caseous necrosis (hematoxylin-eosin staining) (d). The authors certify that they have obtained all appropriate patient consent.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/7ee46128-6608-4d54-95a1-ae2e06f80d70/featured/hero-1781563305805.png","publishDate":"2020-07-18T00:00:00.000Z","doi":"10.25259/SNI_383_2020","categories":["Infection","Image Report"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2020/07/10145/SNI-11-201.pdf"}