Magic Dr.T? Tuberculous brain lesions in an immunocompetent patient-A case report

Abstract

Tuberculomas in the form of multiple ring-enhancing brain lesions is an uncommon occurrence in immunocompetent patient. Central nervous system tuberculosis may manifest as meningitis, tuberculoma, or abscess and can even occur in patients with or without active respiratory tract infection. In the case of active infection, specific antibiotic combinations and dosing duration are required, and respiratory isolation/precautionary measures must be taken by the health care workers and members of the family. Most literature has reported Central nervous system tuberculosis in patients with immunosuppression such as from HIV infection or solid organ transplantation; however, in endemic areas, CNS tuberculoma should be a differential consideration even for immunocompetent patients presenting with ring enhancing lesion (s). Our case highlights the importance of maintaining this clinical suspicion. Early diagnosis and management of our patient helped prevent potentially serious neurological sequelae.

Central nervous system tuberculosis in immunocompetent patients: Two case reports with literature review

“…Because of its high specificity and sensitivity, MR imaging the method of choice for the diagnosis of tuberculomas. The radiologic findings depend on the type of the lesion [1] : Non-caseating tuberculomas demonstrate an iso or high signal intensity on T1WI sequences, while they are hyperintense on T2WI with a homogeneous enhancement on post contrast images. Caseating solid tuberculomas appear hypo-intense On T1WI and T2WI, which is assumed to be due to granulation tissue and compressed glial tissue in the central core, which has a higher cellular density than the brain parenchyma.…”

“…Neoplasms, primary lymphoma of the CNS (central nervous system), pyogenic abscess, fungal infection, cysticercosis, and toxoplasmosis should all be considered in the differential diagnosis of CNS tuberculoma [7] . MR spectroscopy is a valuable method for distinguishing tuberculomas from other intracranial mass lesions and should be performed at the slightest doubt [1] .…”

“…Tuberculosis of the central nervous system (CNS TB) is an uncommon consequence of Mycobacterium tuberculosis [1] . It is a rare, yet an extremely dangerous condition, reported in 5%-10% of extrapulmonary TB cases and accounting for around 1% of all TB cases with a high mortality rate and a high level of neurological morbidity.…”

“…CNS TB is frequently encountered in individuals who are already at high risk, such as those who have HIV co-infection, are using immunosuppressive drugs, are alcoholics, or have cancer [1 , 2] .…”

“…However, it can be difficult to diagnose due to non-specific clinical symptoms and radiological features [1] . As a result, imaging is crucial for prompt diagnosis and lowering morbidity and mortality.…”