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Primary diffuse leptomeningeal gliomatosis mimicking tuberculous meningitis

Muhammet Kosker1, Dicle Sener1, Omer Kilic2

  • 1Division of Infectious Diseases, Clinical Immunology and Allergy, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Journal of Child Neurology
|November 29, 2013
PubMed

Insights

Primary diffuse leptomeningeal gliomatosis is a rare aggressive brain tumor. This case report details a 3-year-old male diagnosed with this condition after initial misdiagnosis.

Area of Science:

  • Neuro-oncology
  • Pediatric Neurology
  • Pathology

Background:

  • Primary diffuse leptomeningeal gliomatosis (PDLG) is a rare and aggressive central nervous system malignancy.
  • It affects the leptomeninges, the membranes surrounding the brain and spinal cord.
  • Fewer than 100 cases have been documented, highlighting its rarity.

Observation:

  • A 3-year-old male presented with symptoms including strabismus, headache, and restlessness.
  • Initial examination revealed left abducens nerve palsy, nuchal rigidity, and bilateral papilledema.
  • Cranial imaging showed contrast enhancement around basal cisterns, initially leading to a tentative diagnosis of tuberculous meningitis.

Findings:

  • Despite antituberculosis treatment, the patient showed no improvement.
  • Craniocervical MRI demonstrated diffuse leptomeningeal contrast enhancement throughout the supratentorial, infratentorial, and spinal compartments.
  • A meningeal biopsy confirmed the diagnosis of primary diffuse leptomeningeal gliomatosis.

Implications:

  • This case underscores the importance of considering rare neurological conditions in pediatric patients with atypical presentations.
  • Accurate and timely diagnosis through advanced imaging and biopsy is crucial for appropriate management.
  • Further research into PDLG is needed due to its aggressive nature and limited reported cases.
Keywords:
childrengliomaleptomeningeal gliomatosistuberculous meningitis

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