Intracranial tuberculomas or neurocysticercosis: differentiated by cervical lymph node pathology

Diagnosis of tuberculomas can be difficult in the absence of pulmonary involvement due to numerable mimics.

We report an immunocompetent 20-year-old female patient, who was admitted with new-onset generalized seizure. Cranial magnetic resonance imaging (MRI) revealed multiple ring-enhancing lesions. There was no reported systemic symptom such as weight loss, fever or night sweating. Polymerase chain reaction for SARS-COV-2 was negative. Computed tomography of thorax was normal. With an initial diagnosis of neurocysticercosis, she was treated with albendazole for one month. Follow-up cranial MRI showed no improvement. On follow-up visit, an enlarged cervical lymph node was recognized. Biopsy of the lymph node led to the diagnosis of tuberculosis. Two months after the onset of anti-tuberculosis therapy, follow-up cranial MRI showed near-complete resolution.

Investigation of any involvement of disease other than the central nervous system can enable accurate and timely diagnosis of tuberculomas in the absence of pulmonary involvement.