ABSTRACT
CONTEXT: Intracranial tuberculomas are rare yet lethal forms of tuberculosis. Diagnosis is often difficult because of its nonspecific symptoms and radiological findings. AIM: This study aims to perform a literature review of multiple tuberculomas to improve disease recognition and management in immunocompetent patients along with presenting a case report on the topic. DATA SOURCES: Scopus, LILACS, Ovid MEDLINE and EMBASE. STUDY SELECTION: Case reports and case series up to December 2018 in English, Spanish, and Portuguese focusing on intracranial tuberculomas in adult and pediatric immunocompetent patients. Data on presentation, diagnostic workup, and treatment was analyzed. DATA EXTRACTION: Cochrane Collaboration/Cochrane Handbook and PRISMA guidelines. RESULTS: Twenty reports involving 21 patients were included. Most patients were male (57.14%). The average age at diagnosis was 26.9 ± 14.9 years. Headache was the most common presenting symptom (52.4%; 11/21), followed by motor weakness (47.6%; 10/21) and vomiting (23.8%; 5/21). MRI was the most used image technique (17/21). Most lesions occurring in the cerebral hemispheres (16/21); we found five or more lesions in 66.6% (14/21) of the patients. The majority treated with anti-tuberculous drugs resulted in a favorable outcome. CONCLUSIONS: Immunocompetent patients living in TB endemic areas whose clinical evaluation and neuroimaging findings are compatible with tuberculoma should undergo anti-tubercular treatment despite a lack of bacteriological confirmation.
Subject(s)
Antitubercular Agents/therapeutic use , Brain Diseases/diagnostic imaging , Glucocorticoids/therapeutic use , Tuberculoma, Intracranial/diagnostic imaging , Tuberculosis, Pulmonary/diagnostic imaging , Blindness/physiopathology , Brain/diagnostic imaging , Brain Diseases/drug therapy , Brain Diseases/immunology , Brain Diseases/physiopathology , Cerebellar Ataxia/physiopathology , Dexamethasone/therapeutic use , Drug Therapy, Combination , Endemic Diseases , Ethambutol/therapeutic use , Female , Humans , Immunocompetence , Isoniazid/therapeutic use , Magnetic Resonance Imaging , Nausea/physiopathology , Nystagmus, Pathologic/physiopathology , Peru , Pyrazinamide/therapeutic use , Quadriplegia/physiopathology , Rifampin/therapeutic use , Tomography, X-Ray Computed , Tuberculoma, Intracranial/drug therapy , Tuberculoma, Intracranial/immunology , Tuberculoma, Intracranial/physiopathology , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/immunology , Vomiting/physiopathology , Young AdultABSTRACT
Two cases of appearance of encephalic tuberculomas during anti-tuberculous treatment in immunocompetent patients are presented. The first an adult man presenting a right frontal lesion which required surgical treatment and the second a girl with multiple lesions located mainly in the brainstem. This paradoxical presentation is attributed to a bizarre immunological reaction between the host and the tuberculosis bacillus. Patients with this condition do not require changes in anti-tuberculous treatment, and steroids are helpful in alleviating the symptoms. Surgery is indicated only for cases of uncontrollable intracranial hypertension or when there is diagnostic uncertainty. The prognosis of this entity is usually good.