Abstract
Pseudotumorcerebri is a general term for a number of non‑neoplastic CNS lesions of various origins that resemble neoplasia clinically and/or radiologically, often cause serious diagnostic mistakes and prescribing unreasonable treatment that may harm the patient. There are currently three types of pseudotumors of the brain, including inflammatory granulomatous lesions, idiopathic or symptomatic intracranial hypertension, and large demyelinating foci in the white matter of the cerebral hemispheres.This scientific publication describes the medical history of a patient with pseudotumor granulomatous temporal lobe encephalitis HSV‑1/2‑etiology, which developed against the background of secondary cellular immunodeficiency caused by long‑term use of methylprednisolone for rheumatoid arthritis. Initially, a misdiagnosis of brain glioma was made due to the similarity of clinical and radiological manifestations of encephalitis with brain tumor. Diagnostic error was identified only during neurosurgery to remove the probable tumor. Histological and immunohistochemical analysis of a brain tissue sample from a pseudotumorous lesion obtained by intraoperative biopsy showed signs of granulomatous macrophage inflammation with moderate microcystosis and a small amount of tissue detritus. The diagnosis of HSV‑1/2 neuroinfection was verified on the basis of PCR of cerebrospinal fluid obtained during neurosurgery. The patient was discontinued previously planned radiation therapy, which was categorically contraindicated in this case, and was prescribed treatment with acyclovir to inhibit the reproductive activity of the virus and dialysable extract of blood leukocytes to eliminate secondary immunodeficiency. Neurosurgical intervention was found to be unjustified. Methylprednisolone was discontinued, and the patient was transferred to an aminoquinolone series drug for the treatment of rheumatoid arthritis. Only after performing these interventions it was possible to achieve a significant improvement in the patient's condition.
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