Tuberculoid Granuloma in the Brainstem: Case Report

Abstract

Meningitis or meningoencephalitis are the most common presentations of Koch bacilli infection on the central nervous system (CNS), especially in immunosuppressed patients, in whom the bacilli normally reaches the meninges and the cerebral parenchyma.. A least common pathological presentation is the tumoral growth pattern disease known as tuberculoma. This pathological entity is more common in the cerebral hemispheres and is rarely located in the brainstem. The present case report describes a case of a 55-year-old patient under regular antiretroviral therapy who was hospitalized with signs of brainstem and cerebellar disturbances. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain showed an exophytic lesion in the dorsal region of the pons. The patient underwent total resection of the lesion and the histopathologic analysis was consistent with a tuberculoma.

Resumo

O acometimento do sistema nervoso central pelo bacilo de Koch é comum, principalmente em pacientes imunossupressos, nos quais normalmente atinge as meninges e o parênquima cerebral, causando quadro de meningite ou meningoencefalite. Contudo, menos comumente, tal acometimento pode formar lesões expansivas conhecidas como tuberculomas. A presença deste tipo de tumoração predomina no parênquima supratentorial, sendo rara sua localização no tronco cerebral. O presente relato de caso tem por objetivo descrever o caso de um paciente de 55 anos, em uso de terapia antirretroviral, que apresentou inicialmente síndrome piramidal alterna com componentes cerebelares. Tomografia e ressonância magnética de crânio mostraram a presença de lesão expansiva exofítica em região dorsal da ponte, no assoalho do quarto ventrículo. O paciente foi submetido à ressecção total da lesão, e o exame anatomopatológico foi compatível com tuberculoma.

Keywords

tuberculoma - granulomatous tuberculosis - brainstem

Palavras-chave

tuberculoma - granuloma tuberculoide - tronco cerebral

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