A case of cerebral tuberculoma mimicking neurocysticercosis

Abstract

CaseA 42‐year‐old Peruvian woman residing in Japan for 11 years with a family history of neurocysticercosis presented to our intensive care unit with fever and intense headache.Computed tomography indicated multiple micronodular lesions in the brain parenchyma, and cerebral tuberculoma and neurocysticercosis were considered in the differential diagnosis. Neurocysticercosis was initially suspected, and oral praziquantel was initiated. However, because of a high adenosine deaminase level in the cerebrospinal fluid and positive peripheral blood interferon gamma release test result, cerebral tuberculoma was subsequently considered.OutcomeAntituberculous drugs with steroids were initiated on day 10, after which the symptoms gradually resolved; the patient was discharged on day 29. Gadolinium‐contrast magnetic resonance imaging 8 months later showed reduced nodular shadows, confirming cerebral tuberculoma.ConclusionImmediate diagnosis and treatment are imperative for cerebral tuberculoma, a lethal infection. Considering the recent increases in immigration worldwide, increased cases of tuberculoma mimicking neurocysticercosis are expected.

Late-onset paradoxical reactions 10 years after treatment for tuberculous meningitis in an HIV-negative patient: a case report

“…Besides, the patient’s symptoms did not get worse during the 2-week hospitalization without anti-TB drugs, and no recurrence of tuberculous meningitis was reported for 1 year under the corticosteroid treatment without anti-TB drugs. Although calcified granulomas with perilesional edema in the brain are sometimes observed in the case of neurocysticercosis [ 10 – 12 ], the patient had no family history and had never visited or lived in neurocysticercosis endemic areas. In addition, we confirmed the negative results of ELISA-based antibody detection tests for T. solium .…”

Neurocysticercosis: mimics and chameleons

“…Cerebral tuberculomas can also be mistaken for neurocysticercosis on imaging 24–26. This can be especially problematic, given that often both conditions partially share endemic areas.…”

“…This can be especially problematic, given that often both conditions partially share endemic areas. Chest radiography and CSF analysis are important in distinguishing the two 26. Tuberculomas are generally larger (>2 cm) than neurocysticerci, and their margins are more irregular.…”

Role of Immuno-Polymerase Chain Reaction (I-PCR) in Resolving Diagnostic Dilemma Between Tuberculoma and Neurocysticercosis: A Case Report

“…It causes high morbidity and mortality, predominantly in children of endemic countries, including India [ 1 ]. Tuberculomas are unique features of central nervous system (CNS) TB that reveal clinical findings similar to NCC caused by Taenia solium [ 1 , 2 ]. Hematogenous spread of tubercle bacilli from the lungs is most common, leading to small subpial infective foci known as rich foci, which form a reservoir for the appearance of intracranial manifestation [ 1 , 3 , 4 ].…”

“…However, tuberculomas also appear with symptoms and signs of focal neurological deficits without systemic disease [ 1 , 3 ]. The conventional neuroimaging modalities such as computed tomography (CT) scan and MRI cannot differentiate the multiple ring-enhancing lesions associated with diseases such as sarcoidosis, neurosyphilis, malignant lesions, pyogenic abscess, cryptococcosis, and toxoplasmosis, as well as NCC and tuber-culomas [ 2 , 5 , 6 ]. MRS is considered a relatively reliable modality to resolve the diagnostic dilemma between NCC and tuber-culomas, as increased lipid peak, >1.0 ratio of choline/creatine, absence of alanine, succinate peak, and decreased level of N-acetylaspartate (NAA) have been demonstrated in tuberculomas formation [ 6 , 7 ].…”