Cerebral tuberculoma as a differential diagnosis for extraaxial lesions in immunocompetent patient: case report

Introduction: Cerebral tuberculomas are a rare and serious form of tuberculosis, representing 0.2% of intracranial expansive processes. In the absence of conclusive diagnostic tests, doctors often make treatment decisions based on clinical judgment, cerebrospinal fluid (CSF) profile, and radiological findings. Magnetic resonance imaging (MRI) commonly shows discrete lesions with ring enhancement, with perilesional edema, being a relevant differential diagnosis in ring lesions, as their clinical and imaging can mimic brain tumors. The aim to report a case of cerebral tuberculoma in an immunocompetent patient. This is a case report study. The information of this work was obtained through review of the medical record. Case report: G.L.F, female, 26 years old, immunocompetent, with a history of generalized tonic-clonic seizure. MRI showed a right temporal extra-axial lesion, with heterogeneous contrast enhancement and adjacent dural thickening, associated with vasogenic edema. CSF was collected for investigation of inflammatory disease, without any significant findings. Excisional biopsy for anatomopathological analysis revealed an epithelioid granulomatous process (complete tuberculoid granulomas) with central caseous necrosis. Based on clinical, laboratory, and imaging data correlation, the conclusion was reached that it was a cerebral tuberculoma. Treatment followed the standard tuberculosis regimen for one year. Conclusion: Mycobacterium tuberculosis infection in the central nervous system, manifested as tuberculoma, although extremely rare, should be considered as a differential diagnosis for expansive brain lesions, especially in regions with a higher prevalence of the disease.