Brain Tuberculoma: A fifty-two-year-old woman case report

Tuberculoma of the brain is one of the most severe extrapulmonary forms that affect patients less than 40 years of age. They are space-occupying masses of granulomatous tissue that result from haematogenous spread from a distant focus of tuberculous infection by Mycobacterium tuberculosis. Symptoms and radiologic features being nonspecific usually leads to misdiagnosis and mimics a variety of other infectious diseases. Anti- Tubercular drugs are essential for the successful treatment of cerebral tuberculomas. A 52-year-old woman with known co-morbidities and chronic kidney disease presented with complaints of disoriented talk, vomiting, fever, and decreased response since 1 day. The initial radiological imaging showed ring-enhancing lesions and a differential diagnosis of septic emboli, vasculitis, and tuberculosis was considered. A repeat MRI suggested Tuberculoma. CSF studies showed predominant lymphocytes with elevated protein. CBNAAT & AFB smears of CSF were negative. The patient was started on anti-tuberculous drugs and steroids. But did not respond to the treatment and twelve days later, a brain biopsy was taken and sent for cultures. She deteriorated progressively and died 14 days after admission. Twelve days after her demise, the Mycobacterial culture of the brain biopsy specimen grew Mycobacterium tuberculosis.