Multiple intracranial tuberculomas mimicking granulocytic sarcomas in acute myeloid leukemia

J Korean Med Sci. 2007 Sep;22 Suppl(Suppl):S171-3. doi: 10.3346/jkms.2007.22.S.S171.

Abstract

The diagnosis of incracranial tuberculoma in immune-compromised hosts is often difficult because conventional magnetic resonance (MR) imaging of tuberculoma reveals various findings and neurologic symptoms are not typical. Here, we report a case of a 54-yr old man with multiple intracranial tuberculoma who was treated for acute myeloid leukemia. He complained of right-side paresthesia after the third consolidation chemotherapy without leukemic relapse and fever. MR imaging of the brain showed multiple ring-enhanced lesions in the cerebrum, cerebellar hemisphere, and pons. The lesions appeared to mimic a metastatic tumor or abscess. Cerebrospinal fluid analysis showed no abnormal cells, but the level of adenosine deaminase was elevated (28.8 IU/L, normal 0-8). Stereotactic brain biopsy was performed, but only reactive gliosis was observed. To confirm diagnosis, an open brain biopsy was performed. The histopathology demonstrated chronic granulomatous inflammation with caseous necrosis. Tuberculous-polymerase chain reaction of the biopsy showed a positive result. He was treated with anti-tuberculosis medication and a high dose of steroid. Paresthesia improved, and follow-up brain MR imaging showed the decreased size and numbers of ring-enhanced lesions and improvement of perilesional edema 1 month after treatment. Here, we report on an interesting case of intracranial tuberculoma in acute myeloid leukemia.

Publication types

  • Case Reports

MeSH terms

  • Antitubercular Agents / therapeutic use
  • Brain Neoplasms / diagnosis*
  • Diagnosis, Differential
  • Humans
  • Leukemia, Myeloid, Acute / complications*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Sarcoma, Myeloid / diagnosis*
  • Tuberculoma, Intracranial / complications
  • Tuberculoma, Intracranial / diagnosis*
  • Tuberculoma, Intracranial / drug therapy

Substances

  • Antitubercular Agents