EUROPEAN JOURNAL OF MEDICAL RESEARCH 163 Abstract We report about a rare case of disseminated Mycobac- terium bovis infection in a 61 year old female immuno- competent patient with involvement of the lung, the brain, the spleen and spine. The patient had intracere- bral tuberculomas with paradoxical enlargement dur- ing the first weeks of therapy. We reviewed the data of our microbiological department and found five other patients with Mycobacterium bovis infection diagnosed between 1999 and 2004, which are 5.8 % of all diag- noses of tuberculosis during this period. Key words: Mycobacterium bovis , disseminated infec- tion, immunocompetent patient, intracerebral tubercu- lomas, central Europe Abbreviations: AFB: acid-fast bacteria, PZA: pyrazi- namide, BAL: bronchoalveolar lavage, ABPA: allergic bronchopulmonary aspergillosis INTRODUCTION Before establishing effective control measures for bovine tuberculosis Mycobacterium bovis (M. bovis) in- fections were a common cause of extrapulmonary tu- berculosis in children, transmitted by unpasteurized milk. In Western Europe and North America this pre- sentation of disease has almost vanished. In 1952 a program to fight bovine Tuberculosis was started in Western Germany. By that time only 10% of the cattle herds were free of tuberculosis after ten years this pro- portion had risen to 99.7% [1]. Eastern Germany was declared free of bovine tuberculosis in 1978. It is esti- mated that in the 50th of the last century approximat- ed 10-30% of all TB cases in Germany were caused by M. bovis, nowadays it is approximately 1 %, most of them are considered to be reactivations [2]. We report on six cases with M. bovis infections di- agnosed in our institution between 1999 and 2004 which represents 5.8 % of all diagnoses of tuberculosis during this period. Patients are older than 55 years, which means that they grew up in a time when tuber- culosis in cattle was still prevalent in Central Europe. So even decades after eradication of bovine tuberculo- sis M. bovis infection still exists in the local popula- tion. CASE REPORT Case one is a 61 year old female patient. Five months before being referred to our department the patient was the first time admitted to a country hospital with restlessness, anxiety, amnesic aphasia and a weight loss of 7 kilograms. Because of a seizure two weeks later a cranial CT scan was done and showed a hypodense left parietal cerebral tumor with extended perifocal edema, which was supposed to be a metastasis or a brain tu- mor. The tumor was resected and histologic examina- tion revealed a granulomatous inflammation with necrosis and vasculitis but without detection of my- cobacteria including PCR. A CT scan of the thorax and abdomen showed no abnormalities. Because of persisting fever an antimicrobial treatment was started but showed no lasting success. CT of the thorax was repeated a few weeks later. This time micronodular in- filtrations were seen in both lungs. Tuberculin testing was negative. A CT scan of the abdomen now revealed multiple hypodense nodules in the spleen and several enlarged paraaortal lymph nodes. A biopsy of the spleen demonstrated granulomatous inflammation. Disseminated sarcoidosis was suspected and steroid therapy was initiated. Two days later the patient was transferred to our institution because of worsening of the general condition. On admission the patient was disoriented, tachyp- noic and had a temperature of 38.2°C. Haemoglobin was 11.2 g/dl and leukocytes 9400 /ml. She had ele- vated liver enzymes (AST 46 U/l, ALT 35 U/l, gGT 383 U/l, AP 318 U/l) and a slightly elevated CRP (9.6 mg/l). No evidence of immunodeficiency (immuno- globulin levels, lymphocyte subpopulations, HIV test) were found. Because either disseminated sarcoidosis or tubercu- losis was possible, glucocorticoid therapy (100 mg/d) was continued and an antimycobacterial therapy with isoniazid, rifampin, ethambutol and pyrazinamide was initiated. Ziehl-Neelsen stains and M. tuberculosis complex PCR (COBAS AMPLICOR MTB system, Roche Diagnostics, Mannheim, Germany) from bron- choalveolar lavage and tracheal secretions were repeat- edly negative, but PCR from stomach secretions was once positive (this sample being culture negative). BAL differential cell count revealed an increased pro- April 28, 2006 Eur J Med Res (2006) 11: 163-166 © I. Holzapfel Publishers 2006 DISSEMINATED MYCOBACTERIUM BOVIS I NFECTION IN AN I MMUNOCOMPETENT HOST N. Schübel 1 , J. Rupp 2 , S.Gottschalk 3 , P. Zabel 4 , K. Dalhoff 1 1 Department of Internal Medicine III, University of Lübeck, Lübeck, Germany 2 Institute of Medical Microbiology and Hygiene, University of Lübeck, Lübeck, Germany 3 Institute of Neuroradiology, University of Lübeck, Lübeck, Germany 4 Research Center Borstel, Germany