Intracranial tuberculoma simulating a malignant tumor: case report and literature review

Extrapulmonary manifestations of tuberculosis involving the central nervous system (CNS) due to haematogenous spread are not a rare entity. Tuberculoma is a granulomatous inflammatory process mimicking in rare occasions a malignant neoplasm radiologically. The authors report a case of a giant right frontal tuberculoma mimicking a malignant tumor and review the literature. A sixty four-year-old women with several weeks of headache and behavior alterations admitted at the hospital with light right hemiparesis. The MRI showed a left frontal tumor suggestive of a malignant tumor. CT showed bone infiltration. At surgery, a nodular, avascular lesion was found and pathological examination confirmed granulomatous inflammation suspecting tuberculoma. Mycobacterium tuberculosis complex-specific PCR assay confirmed diagnosis. Intracranial tuberculoma is an uncommon variety of central nervous system tuberculosis. The prognosis is related to the early diagnosis, surgical resection and the complementary antituberculosis treatment. We present the unusual presentation of a giant brain tuberculoma which MRI led us to believe was a malignant tumor. Computed Tomography revealed bone infiltration. Positive diagnosis could be established on the basis of the pathology results of a brain biopsy or detection of DNA of Mycobacterium tuberculosis in the PCR study.