Tuberculoma of the brain with unknown primary infection in an immunocompetent host.
Isolated cerebral tubercular abscess is uncommon in immunocompetent hosts. Our patient had a tuberculoma with no known primary and an atypical MRI appearance. We present a 67-year-old African-American male with complex partial seizures. A CT scan of the brain revealed a new right frontal mass which was not found on imaging two years prior. In view of the patient's age and absence of any known primary malignancy, a primary brain tumor was considered to be the likely diagnosis. On MRI, the mass did not display ring enhancement or necrosis. Rather, the mass was lobulated, with near-uniform enhancement of the lesion with a surrounding high fluid-attenuated inversion recovery signal predominantly in the right frontal region, which extended inferiorly to the parietal region. The lesion showed a few punctate foci of low signal intensity on gradient echo MRI sequences, suggestive of hemorrhage. The mode of infection is unknown. However, it is important to include tuberculosis as a differential diagnosis, especially if the lesion appears to be non-primary, if a primary neoplasm or other metastases are not identified on further investigation, and in a patient of African-American ethnicity. To our knowledge, this is the first record of an isolated tubercular abscess of the brain in a developed country.
Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL 33136, USA.
Karthik
K
Madhavan
Gabriel
G
Widi
Ashish
A
Shah
Carol
C
Petito
Bruno V
BV
Gallo
Ricardo J
RJ
Komotar
D000368:Aged; D001921:Brain / Q000473:pathology; D001922:Brain Abscess / Q000150:complications / Q000473:pathology; D002494:Central Nervous System Infections / Q000150:complications / Q000473:pathology*; D004569:Electroencephalography; D006099:Granuloma / Q000473:pathology; D006801:Humans; D007121:Immunocompetence; D008279:Magnetic Resonance Imaging; D008297:Male; D009336:Necrosis; D012640:Seizures / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014375:Tuberculoma / Q000209:etiology / Q000473:pathology*