Tuberculous Meningoencephalitis: Intracranial Tumoral Presentation

A 37-year-old Iranian woman presented acutely with decreased level of consciousness and bi-lateral mydriasis to the emergency ward. CT scan and MRI showed a large intracranial mass in the left frontotemporoparietal region of the cerebrum. The clinical and imaging findings were suggestive of an intracranial tumor. Frontotemporal lobectomy was performed and the resected specimen contained white caseating material. Grossly, the resected specimen was white and firm. Microscopically multiple granulomatous le-sions with epitheliod histiocytes and Langerhans giant cells and central caseation were seen, surrounded by inflammatory infiltration of plasma cells and neutrophils as well as meningeal congestion. These findings were compatible with necrotizing granulomatous encephalitis of tuberculosis. Parenchymal CNS tuberculosis with or without extra-cerebral manifestations may present as a space-occupying lesion. Because a tuberculoma is rarely suspected especially if there is atypical morphology, biopsy is required to establish the diagnosis and specific treatment