Intracranial tuberculomas mimicking a malignant disease in an immunocompetent patient

TY - JOUR

T1 - Intracranial tuberculomas mimicking a malignant disease in an immunocompetent patient

AU - Giese, A

AU - Kucinski, T

AU - Hagel, C

AU - Lohmann, F

PY - 2003/6

Y1 - 2003/6

N2 - We present the unusual occurrence of multiple systemic and two central nervous system tuberculomas in an immunocompetent young patient. A large left frontal epidural tuberculoma with transcalvarian extension was removed surgically and chemotherapy was initiated. The patient remained on a chemotherapy with INH, RMP, and EMB and was followed clinically and with MRI scans for 24 months. Findings. The clinical presentation and neuroimaging studies initially suggested malignant disease. Surgical resection of the left frontal lesion was required to relieve the mass effect. The histological evaluation showed a granulomatous inflammation with epithelial and Langhans giant cells, but no acid-fast bacilli. Cultures of the specimens yielded a mixed infection with Corynebacterium species and Staphylococcus epidermidis. Based on the histological findings, chemotherapy for tuberculosis was initiated. Subsequently, Mycobacterium tuberculosis was cultured from the surgical specimen and sputum. Interpretation. Parenchymal CNS tuberculosis with or without extracerebral manifestations may present as a space-occupying lesion. Because a tuberculoma is rarely suspected especially if there is atypical morphology, biopsy is required to establish the diagnosis and expedite specific treatment.

AB - We present the unusual occurrence of multiple systemic and two central nervous system tuberculomas in an immunocompetent young patient. A large left frontal epidural tuberculoma with transcalvarian extension was removed surgically and chemotherapy was initiated. The patient remained on a chemotherapy with INH, RMP, and EMB and was followed clinically and with MRI scans for 24 months. Findings. The clinical presentation and neuroimaging studies initially suggested malignant disease. Surgical resection of the left frontal lesion was required to relieve the mass effect. The histological evaluation showed a granulomatous inflammation with epithelial and Langhans giant cells, but no acid-fast bacilli. Cultures of the specimens yielded a mixed infection with Corynebacterium species and Staphylococcus epidermidis. Based on the histological findings, chemotherapy for tuberculosis was initiated. Subsequently, Mycobacterium tuberculosis was cultured from the surgical specimen and sputum. Interpretation. Parenchymal CNS tuberculosis with or without extracerebral manifestations may present as a space-occupying lesion. Because a tuberculoma is rarely suspected especially if there is atypical morphology, biopsy is required to establish the diagnosis and expedite specific treatment.

KW - Adolescent

KW - Biopsy

KW - Brain Diseases/diagnosis

KW - Brain Neoplasms/diagnosis

KW - Diagnosis, Differential

KW - Drug Therapy, Combination

KW - Female

KW - Humans

KW - Magnetic Resonance Imaging

KW - Mycobacterium tuberculosis/isolation & purification

KW - Tuberculoma, Intracranial/diagnosis

U2 - 10.1007/s00701-003-0019-0

DO - 10.1007/s00701-003-0019-0

M3 - SCORING: Journal article

C2 - 12836079

VL - 145

SP - 513

EP - 517

JO - ACTA NEUROCHIR

JF - ACTA NEUROCHIR

SN - 0001-6268

IS - 6

ER -