Infectious Lesion Simulating Malignant Neoplasm. Clinical Case and Literature Review

Abstract

The extrapulmonary manifestations of tuberculosis (TBC) that affect the Central Nervous System (CNS), by hematogenous dissemination, are an infrequent entity. Intracranial tuberculomas are the least common form of tuberculosis in CNS. Represent a granulomatous inflammatory process with cerebral involvement. The prognosis is related to the early diagnosis, the degree of surgical resection and the complemen-tary treatment with antituberculous drugs. We describe an infrequent clinical case of cerebral tuberculoma that simulated a malignant neoplasm, and also performed a literature review. A clinical case about a 31-year-old female with no relevant medical history. She described a sud-denly diplopia, without previous trauma. The patient was evaluated by Ophthalmology, which iden-tified papillary edema, with no other alterations. In this context was performed a Brain CT/MRI, which showed an intra-axial, left frontobasal lesion with perilesional edema, ring contrast enhancement and a hypodense/hypointense central area. Spectroscopy showed a reduction in n-acetylaspartate (NAA) with a peak in creatine and choline, suggestive of a malignant tumor. The patient underwent surgery, having performed a frontal left craniotomy and complete excision of a nodular, capsulated, avascular lesion with a spongy consistency. Subsequently, the histological diagnosis of tuberculoma was confirmed. We describe an infrequent clinical case of cerebral tuberculoma which, due to the characteristics presented in the preoperative studies, was suggestive of a malignant tumor that was not confirmed, which is the particularity of this case. The patient presents a good clinical and imaging evolution during the follow-up period.