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Tumour-like presentation of brainstem tuberculoma: a lesson learnt
  1. Chia Ming Yeat1,
  2. Hairuddin Achmad Sankala2,
  3. Faizah Mohd Zaki1 and
  4. Shahizon Azura Mohamed Mukari1
  1. 1Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
  2. 2Department of Radiology, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  1. Correspondence to Dr Faizah Mohd Zaki; drfaizah{at}ppukm.ukm.edu.my

Abstract

Brainstem tuberculoma is diagnostically challenging as it lacks clinical clues and imaging mimics a high-grade glioma (HGG). We report the case of an adolescent girl diagnosed with brainstem HGG, who was referred to our centre for Gamma Knife. Initial MRI showed a pontomedullary junction, ring-enhancing lobulated lesion demonstrating distinct central hypointensity on T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR) images with extensive vasogenic oedema. An alternative diagnosis of infection was entertained, and biopsy was suggested; however, the parents opted for a trial of alternative treatment. Suboccipital craniotomy and debulking were only performed 3 months later when her symptoms worsened, and MRI revealed enlargement of the lesion. A cheesy ‘tumour’ was noted intraoperatively; histopathological findings later confirmed chronic granulomatous inflammation. In an endemic area, a high index of suspicion of a tuberculoma is vital specifically in the presence of central T2W/FLAIR hypointensity of a ring-enhancing lesion.

  • Radiology
  • Infectious diseases

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Footnotes

  • Contributors CMY and HAS conceptualised the paper and conducted the literature review. HAS, SAMM and FMZ were involved in revising the manuscript critically of important intellectual content. All authors approved the final version submitted for publication and take responsibility for the statements made in the published article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.