[Paradoxical expansion of intracranial tuberculomas during chemotherapy].

A 45-year-old female patient was admitted to a hospital because of tuberculous meningitis in July, 1986. She was treated with chemotherapy (oral isoniazid, rifampicin, ethambutol and an intramuscular injection of streptomycin). Her consciousness was worsened at first, but later she improved aside from some disabilities (incontinence, gait disturbance, disorientation and dementia). She was transferred to National Higashisaitama Hospital in November, 1986. Since then we have continued the chemotherapy, and she has improved gradually. Initially her cranial computerized tomography (CT) revealed no intracranial tuberculoma and showed mild enhancement of basal cistern. About 4 months later, her CT showed many tuberculomas with ringed or nodular enhancement. About 13 months later almost all tuberculomas disappeared. But a few were found with homogeneous enhancement and were enlarged in spite of adequate chemotherapy. These tuberculomas were enlarged while the chemotherapy was continued, but later they were reduced in size. About 3 and a half years later, these tuberculomas disappeared without any calcifications. The above facts may suggest that intracranial tuberculoma could appear and be enlarged on cranial CT in spite of adequate chemotherapy during a course of tuberculous meningitis. They also suggest that continuation of adequate chemotherapy might improve tuberculomas.