Total regression of CNS lesions in a pediatric patient with suspected neurotuberculosis

*Correspondence: [e-mail].

Abstract

Case Presentation: K.A.B.M, male, 8 years old, previously healthy, presented a case of focal seizure that subsequently generalized, ceasing with the use of Diazepam. He had a history of severe headache in the frontal region, associated with photophobia, occurring 1 to 2 times per month for the past 6 months, which resolved with analgesics. During hospitalization, a cranial CT scan was performed due to suspected stroke, revealing an area of frontal hypodensity on the left side. Further investigation was conducted with a cranial MRI, which showed a nodulariform lesion in the left medial frontal gyrus measuring approximately 1.4 x 1.4 cm, and a nodular image in the right superior parietal lobe measuring around 0.8 cm, both with peripheral enhancement and adjacent edema. Due to suspicion of tuberculosis, a chest CT scan was performed, revealing atelectatic opacities and nodular lesions consistent with granulomatous infectious disease. Through investigation, it was discovered that there was household contact with a family member undergoing treatment for TB. Rifampicin 150mg + Isoniazid 75mg, Pyrazinamide 500mg, and Prednisone 40mg were initiated. After 7 months, a follow-up MRI was performed, showing complete regression of the nodulariform lesions and vasogenic edema.

Discussion: Seizure is one of the most common symptoms of neurotuberculosis, particularly generalized tonic-clonic seizures. The pathophysiology may involve inflammatory mediators in the central nervous system (CNS), causing disruption of the blood-brain barrier, cerebral edema and neuronal hyperexcitability. Tuberculoma form presents as granulomatous lesions resulting from the confluence of multiple tubercles acquired during hematogenous dissemination. They are visualized as discrete ring-enhancing lesions (single or multiple) in the brain, surrounded by perilesional edema. Tuberculoma should be considered as a diagnosis of patients with mass lesions in the brain and relevant epidemiological factors (history of infection or known exposure), as reported in the above case. Due to the high mortality rate, treatment for CNS tuberculosis should be initiated upon suspicion of the diagnosis.

Final Comments: In patients with suspected CNS tuberculosis, immediate treatment should be initiated for better outcomes, therewith high morbidity and mortality. Though, in some cases, total regression of lesions in the central nervous system can be achieved.

 

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Publication History

Article published online:
12 May 2025