Shankar Gokul S, Nair Sreeja, Jacob Teena, Idikula Mercy John
Department of Microbiology, Pushpagiri Institute of Medical Sciences & Research Centre, Thiruvalla, Kerala, India.
Access Microbiol. 2023 Oct 16;5(10). doi: 10.1099/acmi.0.000634.v4. eCollection 2023.
One of the most serious extrapulmonary type of tuberculosis that affects people under the age of 40 is brain tuberculoma. They are space-occupying masses of granulomatous tissue that result from hematogenous spread from a distant focus of tuberculous infection by . Symptoms and radiologic features being nonspecific usually leads to misdiagnosis and mimics a variety of other infectious diseases. Anti-tubercular drugs are essential for the successful treatment of cerebral tuberculomas.
The authors present a case report of a 52-year-old diabetic woman, who presented to the Emergency Department of a tertiary care hospital and was diagnosed with brain tuberculomas with a brain biopsy. Brain tuberculomas are rare and could be overlooked. Therefore, this is an important consideration in cases with higher suspicions, given the rapid decline in patient condition.
Due to their rarity, ambiguous symptoms, and radiographic characteristics, intracranial tuberculomas continue to provide a clinical challenge and must always be considered in the differential diagnosis of cerebral space occupying lesions. As CSF may not yield positivity for both CBNAAT and smear examination, a brain biopsy specimen for culture should always be kept in mind for detecting tuberculoma and initiating anti-tubercular treatment at the earliest.
脑结核瘤是影响40岁以下人群的最严重的肺外结核类型之一。它们是由远处结核感染灶血行播散形成的肉芽肿组织占位性肿块。症状和放射学特征不具特异性，通常会导致误诊，并酷似多种其他传染病。抗结核药物对于脑结核瘤的成功治疗至关重要。
作者报告了一例52岁糖尿病女性病例，该患者到一家三级医院急诊科就诊，经脑活检被诊断为脑结核瘤。脑结核瘤罕见，可能被忽视。因此，鉴于患者病情迅速恶化，对于高度可疑的病例，这是一个重要的考虑因素。
由于其罕见性、症状不明确以及影像学特征，颅内结核瘤仍然是一个临床挑战，在脑占位性病变的鉴别诊断中必须始终予以考虑。由于脑脊液的CBNAAT检测和涂片检查可能均为阴性，因此应始终考虑进行脑活检标本培养，以便最早检测到结核瘤并开始抗结核治疗。
