Case Report Open Access Nabi, Arch Surg Oncol 2015, 1:1 DOI: 10.4172/2471-2671.1000102 Volume 1 • Issue 1 • 1000102 Arch Surg Oncol ISSN: 2471-2671 ASO an open access journal Multiple Isolated Intracranial Tuberculomas Masquerading as Brain Metastases on Radiological Imaging: Success of a Therapeutic Trial Junaid Nabi* Department of Surgery, Shaheed Suhrawardy Medical College and Hospital, Bangladesh Keywords: Intracranial tuberculoma; Brain metastases; Magnetic resonance imaging; Antitubercular chemotherapy Introduction Multiple isolated intracranial tuberculomas are rare. Intracranial tuberculomas (ICTs) are manifestation of infection caused by Mycobacterium tuberculosis, and usually result from hematogenous spread of infection from a primary focus elsewhere in the body, which may be clinically evident or dormant. Tuberculosis, being endemic in the Indian subcontinent, presents in multifarious forms. Intracranial tuberculomas accounts for 10% to 30% of all intracranial masses in the developing world [1]. Although being potentially curable and many modern methods being available for early detection, intracranial tuberculomas are still associated with high morbidity and mortality [2]. Clinical manifestations are atypical and non-specifc and it has been reported that evidence of systemic tuberculosis or exposure to the disease may be absent in 70% of the cases [3], which may lead to delayed diagnosis. In developing countries, a high degree of suspicion is warranted to prevent late diagnosis. Fortunately, imaging modalities such as computed tomography (CT) have immensely improved the accuracy of diagnosing intracranial tuberculoma and has a role in elucidating information about the response to chemotherapy [4,5], when required. However, neoplastic, fungal, and parasitic diseases may show similar features on CT scan [6]. Role of CT-guided brain biopsy is unclear [7]. Magnetic resonance imaging (MRI), on the other hand, is superior to CT scan in demonstrating the extent of the lesion as features of tuberculomas are more distinct from those of abscesses, metastates, and gliomas [8]. Although, tuberculosis is endemic in Bangladesh, there is a scarcity of reports on intracranial tuberculomas. Tis report presents an interesting case of multiple intracranial tuberculomas which presented with prolonged nonspecifc symptoms and mimicked brain metastases on radiological imaging and discusses the imaging features of intracranial tuberculoma along with the role of anti-tubercular chemotherapy as a modality for diagnosis in a limited resource setting. Case Presentation A 43-year-old Bengali male was admitted to our hospital with chief Abstract Tuberculosis is endemic in Bangladesh. It remains a resilient public health concern. Reports on presentation and management of intracranial tuberculoma from Bangladesh are sparse. Despite being potentially remediable, tuberculomas are still a cause of signifcant morbidity and mortality in developing nations. Intracranial tuberculomas can occur as solitary or multiple lesions. Multiple isolated intracranial tuberculomas are rare, and diffcult to discern from brain metastases. A unique case of intracranial tuberculomas is presented, which masqueraded as brain metastases on imaging studies and was diagnosed and treated with a trial of antitubercular chemotherapy. A 43-year-old Bengali male presented to the OPD with headaches and blurring of vision for four months. He was provided symptomatic treatment at his regional hospital, which did not abate his condition and was later referred to our center when he developed severe vomiting. Routine investigations including chest radiograph were clean. CT scan showed bilateral edema in cerebral hemispheres and MRI revealed rounded signal change areas of right frontal lobe and left parietal lobe posteriorly, strongly suggestive of brain metastases. Patient declined biopsy. In view of his past history, a full course of antitubercular chemotherapy was prescribed. Following the medication, patient’s condition improved and at 24 months follow-up, there was complete resolution of the lesion. *Corresponding author: Junaid Nabi, MBBS, Department of Surgery, Shaheed Suhrawardy Medical College and Hospital, Sher-e-Bangla Nagar, Dhaka-1207, Dhaka, Bangladesh, E-mail: junaidnabi07@gmail.com Received September 19, 2015; Accepted October 23, 2015; Published October 30, 2015 Citation: Nabi J (2015) Multiple Isolated Intracranial Tuberculomas Masquerading as Brain Metastases on Radiological Imaging: Success of a Therapeutic Trial. Arch Surg Oncol 1: 102. doi: 10.4172/2471-2671.1000102 Copyright: © 2015 Nabi J. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. complaints of headache and blurring of vision. Te patient had been well till four months before admission, when he developed anorexia and malaise. Afer one month, he developed headache and two weeks later was seen at a local hospital where he was prescribed analgesics afer no abnormality was detected on physical examination, chest radiography, and routine laboratory examinations. He was referred to our hospital afer he developed vomiting and blurring of vision as the regional hospital did not have CT scan or MRI facilities. On admission, the patient also complained of weight loss and night sweating. Te headache was moderate in severity, dull aching in character, intermittent in nature, usually localized in the front of his head but ofen radiated to the sides and back. He had noticed that the pain was more on waking up in the morning, he also reported that afer taking analgesics the pain would subside but his head would feel “heavy”. Family history revealed that his father was a patient of tuberculosis and had not completed the prescribed course of anti-tubercular therapy. On physical examination, he was generally wasted. He had an oral temperature of 38.2°C, pulse rate of 84 per minute, respiratory rate of 17 per minute and blood pressure of 125/82 mmHg. He was found to have papilloedema but otherwise no abnormality was detected. Blood tests revealed elevated ESR (45 mm in frst hour, Westergren Method) and intradermal tuberculin test (Mantoux test) reported an induration of 16 mm. No abnormalities were detected on his chest and skull x-rays. Brain computed tomography (CT) scan reported cerebral edema in Archives of Surgical Oncology A r c h i v e s o f S u r g i c a l O n c o l o g y ISSN: 2471-2671