Intracranial tuberculomas developing while on therapy for pulmonary tuberculosis

We describe the case of a south Asian man who developed symptomatic intracranial tuberculomas while on therapy for pulmonary tuberculosis. The development or progression of intracranial tuberculomas during the course of appropriate antituberculous therapy has been recognised previously. We review the epidemiology, pathophysiology, diagnosis, and treatment of this paradoxical phenomenon. Although the aetiology of this reaction is unknown, it may be related to an enhanced immune response during the course of therapy. Routine brain imaging for all patients diagnosed with tuberculosis is not recommended; however, in patients presenting with new neurological findings, neuroimaging is clearly warranted. Stereotactic brain biopsy should be done whenever the diagnosis of an intracranial tuberculoma is in doubt. When intracranial tuberculomas become symptomatic, antituberculous therapy generally does not need to be changed. Corticosteroids are indicated in all symptomatic cases.