Tuberculoma

Background

Pathophysiology

• Collection of granulomatous tissue that results from hematogenous spread of Mycobacterium tuberculosis
• They are a granulomatous lesion of epithelioid cells and Langerhans giant cells surrounded by lymphocytes
• Progress from non-caseating to solid with central caseation to central liquifaction
  • The last stage is indistinguishable from other brain abscesses but has low bacillary burden
• In the CNS, may rupture and cause tuberculous meningitis

Epidemiology

• Cerebral tuberculomas are more common in patients with HIV
  

Clinical Manifestations

Cerebral Tuberculoma

• Often asymptomatic
• Most commonly presents in conjunction with tuberculous meningitis, though can present alone
• In CNS, may present with headache, seizures, or focal neurological deficits
• There are numerous case reports of intracranial tuberculomas developing while on therapy1

Pulmonary Tuberculoma

• Typically asymptomatic, developing at the site of initial disease
• Usually static, but can cavitate and spread new disease

Other Sites

• Also case reports of tuberculomas in liver, heart, peripheral nerve, spine

Differential Diagnosis

• Neurocysticercosis

Diagnosis

• Based on imaging, with ring-enhancing lesion with surrounding edema
• If there is uncertainty about the diagnosis, may need biopsy

Management

• Manage per primary diagnosis, with at least 6 months of standard therapy
• Dexamethasone can be considered for CNS tuberculoma with surrounding vasogenic edema and neurologic symptoms