A Rare Presentation of Central Nervous System Tuberculomas in an Immunocompetent Patient

Abstract

The uncommon presentation of simultaneous brain and lung lesions in an immunocompetent adult patient with frequent travel to a mycobacterium tuberculosis (MTB) endemic area requires high clinical suspicion for central nervous system (CNS) MTB, as this disease often results in severe neurologic morbidity and mortality. Non-specific and subacute symptoms make the diagnosis of CNS MTB clinically challenging, and a workup with imaging and microbiological studies such as acid-fast bacilli staining, nucleic acid amplification testing, and tissue culture must not delay prompt treatment with anti-tuberculosis therapy. This case illustrates the complex challenges of medical diagnosis and multi-disciplinary decision-making involved in the workup of CNS MTB.

Keywords: central nervous system; mycobacterium tuberculosis; simultaneous brain and lung lesions.

Figure 1.

Multiple areas of increased T2 signal on the T2 FLAIR sequences throughout both hemispheres with right to left midline shift of approximately 3 mm.

Figure 2.

MRI showing innumerable ring enhancing masses throughout the brain parenchyma with extensive vasogenic edema with largest mass measuring 2.0 × 1.4 × 1.2 cm in the right temporoparietal region.

Figure 3.

Non-contrast chest CT significant for bi-apical consolidations with air bronchograms suspicious for tuberculosis.