A case of multiple intracerebral
tuberculoma occurred in the course of anti-tuberculous
therapy is reported. A 16-year-old high school boy had been treated with isoniagid,
streptomycin and paramino-
salicylic acid on the tuberculous pleulitis for 3 months previously. He was admitted to our hospital because of progressive
headache associated with
vomiting. Neurological examination revealed bilateral full
papilledema and incomplete bilateral
abducens palsy. An immediate CT study with contrast enhancement demonstrated two small ring-like mass with considerable perifocal
edema in the left temporal and occipital lobe, respectively. Intracerebral
tuberculoma was considered to be most likely, so the patient was given antituberculous
therapy with
steroid and
mannitol. However, despite of medical
decompression, he developed
intracranial hypertension aggravated, leading to removal of
tumor 7 days after admission. Initially left temporal
tuberculoma, which had more extensive and prominent perifocal
edema, was successfully excised. The specimen was a walnut-sized
granuloma with hard
capsule including
pus inside. Numerous tuberculous bacilli were identified with Ziel-Nielsen staining technique from the
pus. Postoperative course was gratifying, and other
tumor in the left occipital lobe, which was also diagnosed as
tuberculoma, was treated with continuing administration of isoniagid, ethanbutol and
rifampicin. However, the former two drugs were forced to be discontinued because of
agranulocytosis. Only
rifampicin was maintained for 2 months thereafter but no decrease of the size was observed in serial CT studies. Then left occipital
tuberculoma was removed. The pathology was
tuberculoma with positive bacilli staining. He discharged 1 month later without any neurological deficit but was on antituberculous
therapy (rifampisin) as an outpatient for 3 years.(ABSTRACT TRUNCATED AT 250 WORDS)