Case Report: A Case of Intracranial Tuberculoma in a Young Man from Ethiopia without Pulmonary Tuberculosis

Introduction: Tuberculosis (TBC) is an infectious disease which usually primarily involves the lungs but can expand to many organ systems including the central nervous system.

An intracranial tuberculoma can mimic a brain tumor or metastasis in radiological morphology and clinical symptoms and remains a rare disease in Western countries. Because of globalization and increasing immigration from third world countries this disease may occur with a higher incidence and has to be considered as a differential diagnosis for an intracranial mass lesion.

Case Report: A right handed, 21 year old otherwise healthy young man from Ethiopia living in Switzerland for 3 years, complained of persistent headaches for one month. Neurological examination was normal. Magnetic resonance imaging revealed a solitary lesion in the left insular lobe. Chest X-ray and abdomen sonography were normal and a HIV-test negative. He had no fever and inflammatory markers were normal.

Tumor resection was performed under awake conditions with no postoperative deficits and an uneventful perioperative course. The tumor could completely be resected. Histology revealed a necrotising granulomatous inflammation of tuberculous type confirmed by PCR. Anti-tuberculosis therapy was started.

Epidemiology: 60% of the TB cases worldwide in 2016 occurred in just 6 countries: India, Indonesia, China, Nigeria, Pakistan and South Africa (from 2’850’000 mio to 450’000)…

In the Western world, TBC cases and particularly intracranial manifestations still remain rare (0.15%−0–18% of all brain tumors)…

In contrast, tuberculomas are significantly more common in the developing world…

Therapy

Discussion: Tuberculomas, which appear intracranial usually in multifocal form, may remain silent for a long time until they develop a mass effect on the brain and became so symptomatic depending on their location, size and perifocal edema.

Like other pathologies, the importance and the geographical spread of TBC and thus its cerebral manifestations will increase due to globalisation and immigration. Clinicians and neurosurgeons should always be aware of this important differential diagnosis; even more if there is a reduced or compromised immune system (HIV, immunosuppressants etc.).

Early recognition of TBC cases also allows the protection of the medical team, who may then wear intraoperative TBC-masks to avoid infection.