Diffuse leptomeningeal tuberculoma masquerading as leptomeningeal gliomatosis: a case report and review of literature

Tuberculosis (TB) of the central nervous system (CNS) is symptomatic in 10-20% of patients with extra pulmonary TB, and merely 1% of patients advance into intracranial tuberculoma1,2. Tuberculomas of the leptomeninges are rarer than the intracranial localizations2-4. It is very important to note that the immune system influences the different types of presentation of TB lesions. The pathological progression of the lesions from the time of first contact with mycobacterium depends on the immune response of the patient5. Tuberculoma can be found in any part of the intracranial space and most often leads to increase intracranial pressure. The lesion may be solitary or multiple and may be seen with or without meningitis6. To the best of our understanding, only a few authors have reported cases of leptomeningeal tuberculoma and almost all the cases were solitary or multiple presentations and not diffused. We, therefore, present a rare case of diffuse leptomeningeal tuberculoma masquerading as leptomeningeal gliomatosis and review of literature. ABSTRACT: — Introduction: Tuberculoma limited to the meninges as a result of mycobacterium tuberculosis infection is very rare and few cases have been reported on this clinical entity. Although some authors have described solitary forms of this presentation, no one reported a case on this diffuse occurrence. This diffuse pattern made the lesions mimic leptomeningeal gliomatosis on imaging studies. — Case presentation: We present a case of a 72-years old man with a two (2) months history of right lower limb weakness and slurred speech which he initially did not take into a great deal of consideration. He had no cough, fever or chills, syncopal episodes. He has a past medical history of splenectomy and cholecystectomy as a result of a car accident 8 years before. Contrast enhanced MRI performed at our facility showed left diffused temporo-parieto-occipital meningeal thickening with multiple parenchymal nodules. — Conclusions: Leptomeningeal tuberculomas should be suspected in patients who present with diffuse lesions of meninges although solitary or multiple forms of this kind of presentation frequently occur. The progress of the lesions or pathology from the time of first contact with mycobacterium depends on the immune response of the patient as well as the number and type of virulent strains involved. Open surgical biopsy to confirm the diagnosis is a very critical diagnostic step. The main treatment option is anti-TB medication and patients must be followed for a long time with series of imaging studies.