Multiple intracranial tuberculomas mimicking granulocytic sarcomas in acute myeloid leukemia.

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.

• Authors: Jae Sook Ahn, Duk Hwan Yang, Yoe Kyeoung Kim, Sang Hee Cho, In Young Kim, Je Jung Lee, Ik Joo Chung, Hyeoung Joon Kim
• Journal: Journal of Korean medical science (J Korean Med Sci) Vol. 22 Suppl Pg. S171-3 (Sep 2007) ISSN: 1011-8934 [Print] Korea (South)
• PMID: 17923749 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antitubercular Agents

Topics

• 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, diagnosis, drug therapy)