Multiple intracranial tuberculomas mimicking granulocytic sarcomas in acute myeloid leukemia.
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.
Ahn
Jae Sook
JS
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Yang
Duk Hwan
DH
Kim
Yoe Kyeoung
YK
Cho
Sang Hee
SH
Kim
In Young
IY
Lee
Je Jung
JJ
Chung
Ik Joo
IJ
Kim
Hyeoung Joon
HJ
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
D000995:Antitubercular Agents