Cystic Mesenteric Inflammatory Pseudotumor Associated to MDR
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Abdominal masses in childhood have a very large spectrum of benign and malignant causes. Inflammatory pseudotumor (IP) arising from intra-abdominal sites has only rarely been designated previously in children. We report the case of a 21-year-old HIV-negative man, in whom a cystic mesenteric IP appeared after 46 months of diagnosis of tuberculous meningitis (TBM) complicated with brain infarcts, tuberculoma, hydrocephalus and multiple neurosurgical procedures including ventriculoperitoneal (VP) cerebrospinal fluid (CSF) shunt placement, shunt exchanges and endoscopic ventricular septostomies.

At diagnosis, primary antituberculous drugs were administered and mycobacterial CSF cultures were persistently negative; nevertheless, follow-up elevated adenosine deaminase levels in CSF suggested multidrug-resistant (MDR) tuberculosis and moxifloxacin and aminoglycoside were added with improvement. Repeated formation of abdominal cystic masses with shunt obstructions, abdominal distention and pain lead us to conclude that the peritoneum was no longer useful for CSF derivation and a ventriculoatrial shunt was placed. After laparoscopic excision of an abdominal mass, microscopic examination showed a cystic tumor formed by proliferation of fibroblasts, myofibroblasts, and inflammatory cells. Diagnosis of IP associated with MDR tuberculosis was made...

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