Intracranial multiple tuberculomas: 2 unusual cases

Area of Science:

• Neurology
• Infectious Diseases
• Radiology

Background:

• Tuberculosis (TB) remains a significant global health concern, causing widespread morbidity and mortality.
• Intracranial tuberculomas (Tbm) are a rare manifestation of TB, typically occurring in 1% of TB patients, often as part of miliary TB.
• Radiological findings for Tbm are often nonspecific, necessitating a high index of suspicion for diagnosis.

Observation:

• This report details two uncommon cases of multiple intracranial tuberculomas (Tbm).
• Case 1: A 32-year-old woman with no pulmonary TB, diagnosed histopathologically and treated with chemotherapy.
• Case 2: A 12-year-old girl with pulmonary TB, portal hypertension, and liver cirrhosis, diagnosed via clinical, radiological, and laboratory findings.

Findings:

• Multiple intracranial tuberculomas (Tbm) can occur even without apparent primary TB infection.
• Liver cirrhosis and immunocompromised states are risk factors for developing intracranial Tbm.
• Histopathological confirmation via biopsy is recommended when no other active extracranial tuberculous process is identified.

Implications:

• Intracranial tuberculomas (Tbm) require consideration in differential diagnoses of brain space-occupying lesions, particularly in endemic TB regions.
• Prompt antituberculous chemotherapy is effective for intracranial tuberculomas (Tbm).
• The association of multiple intracranial tuberculomas with liver cirrhosis in an adult patient is notably rare and warrants further investigation.