A 48-year-old woman complained of
fever,
headache and
nausea in October, 1994. Because polymerase chain reaction (PCR) was positive for mycobacterium tuberculosis in her cerebrospinal fluid, she was administered anti-tuberculous drugs.
Steroid hormone was also administered for her symptoms of
intracranial hypertension. However, multiple intracerebral masses appeared on CT and MRI 2 months later, and have increased in number and size. Cessation of the
steroid hormone was impossible as her
intracranial hypertension had been deteriorated. She was transferred to our clinic on October 23, 1995. On neurological examination she was drowsy and showed
papilledema, weakness of bilateral lower extremities, left cerebellar sign, and bilateral Babinski's reflexes. Enhanced CT and MRI revealed multi-locular lesions in the right fronto-temporal, left temporal and left cerebellar regions. On November 7, 1995 she was operated on. Right fronto-temporal and left cerebellar masses were partially removed. Pathological examination and PCR of the surgical specimens demonstrated
tuberculoma. Postoperatively, her consciousness disturbance improved and the residual
tuberculomas decreased in size under the influence of anti-tuberculous drugs and cessation of the use of
steroid hormone. Recently,
tuberculosis is common neither in Japan nor in Western countries. Intracerebral
tuberculoma is also very rare. The
tuberculosis in our patient with multiple intracerebral
tuberculomas resistant to antituberculous drugs was thought to have been induced by decreased resistance to the
infection due to the administration of the
steroid hormone.