Cerebral Tuberculoma without Clinical Pulmonary Tuberculosis Mimicry as Cerebral Abscess: (A Rare Case Report)

Badrul Munir

doi:10.34297/ajbsr.2019.05.000921

Abstract

Cerebral Tuberculoma without Clinical Pulmonary Tuberculosis Mimicry as Cerebral Abscess: (A Rare Case Report)

Highlights

Cerebral tuberculoma is one of the rare extrapulmonary tuberculosis infection that needs serious concern, due to hematogenous spread [1,2]
Cerebral tuberculoma is approximately 10-15% of intracranial tuberculosis cases and 1% of all Mycobacterium tuberculosis (MTB) cases [4,5]
The gold standard for cerebral tuberculoma is caseosa granuloma found in tissue sample histopathology along with the central necrosis surrounded by histiocytes epithelium

Summary

Introduction

Cerebral tuberculoma is one of the rare extrapulmonary tuberculosis infection that needs serious concern, due to hematogenous spread [1,2]. Radiological examination can help diagnosing the cerebral tuberculoma. Management of cerebral abscess for 14 days but there is no clinical improvement, we performed head MR spectoscopy and suggested cerebral tuberculosis with increased lactate, NAA degradation, and increased choline/creatine ratio in lesion (Figure 3). Physical examination showed a good patient consciousness with GCS of 456, right hemiparese with the upper limb and lower limb power were 2 and 4 respectively, and presence of smelly yellowish discharge in both ears. The discharge Ziehl Neelsen test and Gene expert result showed negative result. Sputum gene expert result showed negative result. Chest X ray and sputum examination gen expert didn’t detect tuberculosis infection (Figure 1). Head contrast MRI showed multiple lesions in cerebellum, right parietal lobe, and left occipital lobe accompanied by cerebral edema, suggestive of cerebral abscess (Figure 2). We have given intravena antibiotik for Figure 2: Head MRI: Multiple lession in right cerebellar and left parietal with edema cerebri sugesting absess cerebri

Findings

Discussion

Conclusion