Multiple intracranial tuberculomas mimicking granulocytic sarcomas in acute myeloid leukemia

Abstract

The diagnosis of incracranial tuberculoma in immune-compromised hosts is often difficult because conventional magnetic resonance (MR) imaging of tuberculoma reveals various findings and neurologic symptoms are not typical. Here, we report a case of a 54-yr old man with multiple intracranial tuberculoma who was treated for acute myeloid leukemia. He complained of right-side paresthesia after the third consolidation chemotherapy without leukemic relapse and fever. MR imaging of the brain showed multiple ring-enhanced lesions in the cerebrum, cerebellar hemisphere, and pons. The lesions appeared to mimic a metastatic tumor or abscess. Cerebrospinal fluid analysis showed no abnormal cells, but the level of adenosine deaminase was elevated (28.8 IU/L, normal 0-8). Stereotactic brain biopsy was performed, but only reactive gliosis was observed. To confirm diagnosis, an open brain biopsy was performed. The histopathology demonstrated chronic granulomatous inflammation with caseous necrosis. Tuberculous-polymerase chain reaction of the biopsy showed a positive result. He was treated with anti-tuberculosis medication and a high dose of steroid. Paresthesia improved, and follow-up brain MR imaging showed the decreased size and numbers of ring-enhanced lesions and improvement of perilesional edema 1 month after treatment. Here, we report on an interesting case of intracranial tuberculoma in acute myeloid leukemia.

Fig. 1

T2-weighted axial image shows multiple ring-enhanced masses with a high signal in the central portion and the perilesional edema (left upper), and a gadolinium-enhanced T1-weighted image shows multiple ring enhancement (right upper) (A). One month after the initiation of anti-tuberculosis treatment, multiple lesions in the brain showed decreased size and number with improving perilesional edema (B).

Fig. 2

Photomicrograph of histologic examination demonstrated granulomatous inflammation (A) and mycobacterium tuberculosis polymerase chain reaction showed positive findings (B).