ArticleThe American journal of case reports2026
Right Temporal Lobe Tuberculoma Presenting as Seizures in a Patient With Pulmonary Tuberculosis.
Article in The American journal of case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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9 authors.
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Abstract
BACKGROUND Central nervous system (CNS) manifestations of tuberculosis (TB) account for approximately 1-2% of all TB cases worldwide. Tuberculomas, which are granulomatous lesions of the CNS diagnostically confirmed through biopsy, can mimic more common intracranial pathologies, including abscesses and neoplasms. This report describes a patient with pulmonary TB who presented with seizure and was ultimately diagnosed with a right temporal lobe TB mimicking a brain abscess. CASE REPORT A 30-year-old woman with alcohol use disorder, polysubstance use, and pulmonary TB previously treated with rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) presented to the emergency department (ED) following a generalized seizure. Anti-tuberculous therapy had been interrupted for several months due to alcohol-related hepatotoxicity. Prior imaging demonstrated a small right temporal lobe lesion, which subsequently enlarged and developed rim-enhancing features after RIPE therapy was interrupted. Given the diagnostic uncertainty and her clinical course, neurosurgical intervention was pursued. Craniotomy with surgical exploration and biopsy revealed necrotizing granulomas and a Ziehl-Neelsen stain confirmed acid-fast bacilli (AFB), confirming intracranial tuberculoma. Postoperatively, she was restarted on a modified anti-tuberculous regimen. CONCLUSIONS Intracranial tuberculoma should remain a key differential diagnosis for ring-enhancing lesions, even in immunocompetent patients and in low-incidence regions. Further, it underscores the importance of maintaining therapy continuity to prevent disease progression. Importantly, when response to therapy is uncertain or adherence is questionable, clinicians should maintain a low threshold for deciding to perform early biopsy to confirm the etiology.
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