Tuberculoma of deep peroneal nerve- a rare case report

Tuberculosis can mimick various diseases, causing a diagnostic dilemma.Tuberculomas of peripheral nerves arerare, only 9 cases were reported till date, we report a case of tuberculoma of deep peroneal nerve. A 29 year old subject, presented with complaints of painful swellings over right leg& foot since 2months. Patient developed diffuse swelling of right lower limb 5 years ago, for which he was treated with NSAIDs & serratiopeptidase by a local practitioner for 2 weeks after which he noticed tiny swellings on lower half of right shin & right foot which grew in size gradually &became painful since 2 months. Examination revealed tiny palpable mobile nodular soft swellings over lower aspect of right leg & over right foot. Ultrasonography of the swellings showed multiple ovale capsulated hypoechoic swellings largest measuring 18.9∗6.1 mm in the mid/lower leg subcutaneous plane anteriorly & similar lesions in the lower leg & dorsum of foot, suggesting benign neoplastic etiology of neural origin. Excision biopsy from deep peroneal nerve sheath tumour showed extensive areas of caseous necrosis with few epitheloid clusters with dense lymphocytic collections in the periphery, suggesting caseating granulomasof tubercular etiology. After making a diagnosis of tuberculoma of deep peroneal nerve, the patient has been initiated on Anti tubercular therapy & the patient respoded to ATT. Tuberculomas of peripheral nerves are rare. Final diagnosis comes from histopathology that reveals caseous necrosis surrounded by epitheloid histiocytes with or without granulomas Nerve exploration, lesion resection, and ATT results in good neurological recovery.