Multiple Cerebral Tuberculomas in an Immunocompetent Individual
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Abstract
Tuberculosis remains a major public health issue in Morocco and a highly endemic disease. While pulmonary involvement is the most common and frequent clinical presentation, CNS tuberculosis accounts for only a small percentage of extrapulmonary cases, carrying the highest rates of mortality and neurological morbidity. We present the case of a 66-year-old male patient with no remarkable medical history, notably no recent tuberculosis exposure, who was admitted to our Trauma Center for an afebrile acute altered mental status, GCS of 13/15. Notably, the clinical neurological examination revealed no meningeal signs or neck rigidity, along with the absence of any respiratory symptoms.
At first, the brain CT scan revealed multiple parenchymal lesions in both the supratentorial and infratentorial compartments, which were exerting a mass effect causing a subfalcine herniation. The lesions were in favor of three diagnoses: tuberculomas, abscess or a brain tumor. Later on, the chest X-ray showed no significant abnormality and the GeneXpert testing that had been conducted confirmed the tuberculous origins.
The patient was immediately started on anti-tuberculosis therapy and high-dose intravenous corticosteroids to control the vasogenic edema, while awaiting further advanced neuroimaging (contrast-enhanced CT and MR spectroscopy). In the following days, the patient’s symptoms significantly improved and he regained consciousness.
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