Outcomes of Pulmonary Tuberculoma Following Standard Antituberculosis Therapy: An Observational Study

Tuberculosis (TB) in Indonesia causes a high burden, with pulmonary tuberculoma representing a mass-like manifestation that poses diagnostic and therapeutic challenges due to poor drug penetration. Data regarding the treatment duration and outcomes of pulmonary tuberculoma remain limited. This study aims to evaluate characteristics and outcomes of pulmonary tuberculoma following standard anti-TB therapy in Indonesia.

This retrospective study evaluated pulmonary tuberculoma confirmed with histopathological findings of granulomatous inflammation at the National Respiratory Center in Indonesia, between 2022 and 2025. Enrolled subjects had completed anti-TB therapy. Clinical and radiological outcomes were evaluated upon treatment completion. Tuberculoma size was measured as the longest diameter on a computed tomography scan. Radiological response was categorized as complete resolution, decreased (≥30% reduction), increased (≥20% increase), or stable (the remainder).

A total of 38 subjects were analyzed. The most common radiological characteristic was multiple, irregular lesions, with a median size of 4.4 cm (range: 1.4-10.1 cm). The median treatment duration was 12 months (range: 6-18 months). All subjects achieved clinical improvement, while sequelae were reported in 5 (13.2%) subjects. Radiological evaluation showed complete resolution in 9 (23.7%) subjects, decreased in 15 (39.5%), and stable in 14 (36.8%). Bivariate analysis revealed that positive microbiological status was significantly associated with lower odds of complete resolution (odds ratio = 0.17, 95% confidence interval: 0.03-0.85, P = 0.036). A single tuberculoma was also associated with complete resolution, while none of the patients with multiple tuberculomas achieved complete resolution ( P = 0.014). Multivariate analysis was not performed due to the limited number of events.

The treatment duration for pulmonary tuberculoma varies from 6 to 18 months, with nearly two-thirds of patients achieving radiological improvement. Positive microbiological status and multiple lesions are significant factors associated with incomplete radiological resolution.