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Paradoxical Growth of Optochiasmatic Tuberculoma during the Treatment of Tuberculous Meningitis

Arjan Idrizaj

Abstract


Tuberculosis (TB) is the 7th leading cause of death and disability worldwide and has reached epidemic proportions in both developed and undeveloped nations. Approximately 5 to 10% of tuberculosis cases involve the brain and central nervous system. Tuberculomas account for 10 to 30% of intracranial (IC) masses in TB-endemic areas. The clinical and neuroimaging features of tuberculoma are variable and may pose a diagnostic challenge in the absence of systemic TB or tuberculous meningitis. Intracranial brain parenchymal tuberculomas may form paradoxically, days to months after starting antituberculous drug therapy. Tuberculomas may develop in and around optic chiasm and optic nerves after institution of antituberculous treatment as a quite rare occurrence in TBM this may lead to severe visual loss if not treated properly. We describe a 5 year-old child with documented TBM being treated with first line antituberculous drugs which developed visual impairment 3 months after starting the treatment. MRI after gadolinium administration revealed multiple perichiasmatic ring enhancing lesions due to tuberculomas. We recommended a treatment with corticosteroids and antituberculous therapy. Visual impairment developing in a patient on treatment with antituberculous drugs should give rise to a suspicion of rare optochiasmatic tuberculomas; this necessitates urgent contrast-enhanced MRI of the brain and prompt treatment with steroids.

Keywords: Optochiasmatic tuberculoma, Paradoxical response, Tuberculous meningitis, Tuberculoma, MRI, etc.


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© 2012-2022 ANGLISTICUM. Journal of the Association-Institute for English Language and American Studies,Tetovo, North Macedonia.

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