Neurotuberculosis mimicking brain tumour; A case report.
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Date
2013-04
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Abstract
Summary: Neurotuberculosis is one of the grave complications of primary tuberculous infection. Extensive BCG vaccination
of children and inadequate antituberculous drug therapy have led to the emergence of newer complex clinical pictures and
diagnostic dilemma. Here we report a case of right-sided hemiparesis with features of raised intracranial tension in a sixyear-
old boy. Neuroimaging revealed presence of a high grade astrocytoma. On clinical examination, right-sided cervical
lymphadenopathy with discharging sinus and tenderness over right hip joint were present. On further investigation, these
were proved to be of tubercular origin. All preliminary findings were in favour of disseminated tuberculosis, but the nature
of CNS lesion was creating diagnostic dilemma. Etiological diagnosis of the CNS lesion was necessary, as, if it was not of
tubercular origin, the management protocol would be different and with any delay we could have lost the patient. Though
on routine CSF study, no AFB were present, but we confirmed the presence of mycobacterial DNA by polymerase chain
reaction. Patient showed considerable improvement after being put on Anti-tubercular Treatment (ATT) and steroids.
Tuberculous brain abscess is rare. Very few cases have been reported even in adults. Most reported cases are in
immunocompromised patients. This case highlights the fact that tuberculous brain abscess can have atypical presentation
even in immunocompetent children mimicking CNS malignancy. Careful examination and thorough investigation are
required to establish the diagnosis. Timely initiation of appropriate therapy can reduce mortality and neurological
sequelae.
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Keywords
Neurotuberculosis, Astrocytoma
Citation
Ghosh Tarak Nath, Pati Sananda, Sangita De, Ghosh Mrinal Kanti. Neurotuberculosis mimicking brain tumour; A case report. Indian Journal of Tuberculosis. 2013 Apr; 60(2): 114-117.