[A case of intracerebral tuberculoma resistant to therapy]

A 48-year-old woman complained of fever, headache and nausea in October, 1994. Because polymerase chain reaction (PCR) was positive for mycobacterium tuberculosis in her cerebrospinal fluid, she was administered anti-tuberculous drugs. Steroid hormone was also administered for her symptoms of intracranial hypertension. However, multiple intracerebral masses appeared on CT and MRI 2 months later, and have increased in number and size. Cessation of the steroid hormone was impossible as her intracranial hypertension had been deteriorated. She was transferred to our clinic on October 23, 1995. On neurological examination she was drowsy and showed papilledema, weakness of bilateral lower extremities, left cerebellar sign, and bilateral Babinski's reflexes. Enhanced CT and MRI revealed multi-locular lesions in the right fronto-temporal, left temporal and left cerebellar regions. On November 7, 1995 she was operated on. Right fronto-temporal and left cerebellar masses were partially removed. Pathological examination and PCR of the surgical specimens demonstrated tuberculoma. Postoperatively, her consciousness disturbance improved and the residual tuberculomas decreased in size under the influence of anti-tuberculous drugs and cessation of the use of steroid hormone. Recently, tuberculosis is common neither in Japan nor in Western countries. Intracerebral tuberculoma is also very rare. The tuberculosis in our patient with multiple intracerebral tuberculomas resistant to antituberculous drugs was thought to have been induced by decreased resistance to the infection due to the administration of the steroid hormone.