title: 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.
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Jae Sook
authors.initials: JS
authors.lastname: Ahn
authors.forename: Duk Hwan
authors.initials: DH
authors.lastname: Yang
authors.forename: Yoe Kyeoung
authors.initials: YK
authors.lastname: Kim
authors.forename: Sang Hee
authors.initials: SH
authors.lastname: Cho
authors.forename: In Young
authors.initials: IY
authors.lastname: Kim
authors.forename: Je Jung
authors.initials: JJ
authors.lastname: Lee
authors.forename: Ik Joo
authors.initials: IJ
authors.lastname: Chung
authors.forename: Hyeoung Joon
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D023981:Sarcoma, Myeloid / Q000175:diagnosis*; D016862:Tuberculoma, Intracranial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents