Multiple meningeal tuberculomas recurring after 18-month anti-tuberculous chemotherapy--case report

A 26-year-old man with multiple intracranial masses widely attached to the dura presented with hypopituitarism and sexual impotence. Magnetic resonance imaging showed the lesions were isointense on the T1-weighted and hypointense on the T2-weighted images, and involved the bilateral sphenoid ridges, the convexity, and tentorial incisura. The lesion was partially removed via the right pterional approach. Histological examination identified tuberculoma associated with giant cells and caseous necrosis. Although his neurological and radiological signs worsened paradoxically during anti-tuberculosis therapy, he recovered spontaneously upon continuation of the anti-tuberculous treatment. However, he suffered recurrence as tuberculous meningitis, after administration of anti-tuberculous therapy for 18 months. Additional anti-tuberculous treatment for 12 months stabilized the disease. Tuberculoma should be included in the differential diagnosis of enhanced intracranial mass lesions. Anti-tuberculous therapy may require extended periods of up to 36 months to stabilize the disease.