A patient with primary intracranial granuloma with difficulty in differential diagnosis: A case report and literature review

There are few reports about primary intracranial granulomas without an identifiable infectious history. A 25-year-old male with intracranial granuloma. The patient presented with a history of tinnitus with intermittent headache for 1 week. Consequently, MRI showed pronounced and extensive enhancement lesions in the left frontal lobe involved in the cerebral longitudinal fissure cistern and the inside of the right frontal lobe, accompanied by a moderate degree of oedema; The lesion was a pilomyxoid astrocytoma preoperatively. Following a systemic examination, gross total resection of the lesion was performed, and postoperative pathological examination revealed the presence of inflammatory lesions. The patient exhibited notable symptom amelioration post-surgery, leading to discharge after the treatment. Subsequently, a sequential treatment involving steroid therapy was administered, resulting in successful patient recovery. •This case highlights presentation of primary intracranial granulomas without identifiable infectious history is rare, challenging diagnostic efforts.•The case underscores the diagnostic challenge posed by intracranial granulomas, often mimicking tumours, necessitating meticulous clinical and radiological evaluation.•This report highlights the importance of considering inflammatory granulomas in the differential diagnosis of intracranial space-occupying lesions, particularly in cases lacking systemic infection or surgical history.