Tuberculoma

A tuberculoma is a clinical manifestation of tuberculosis which conglomerates tubercles into a firm lump, and so can mimic cancer tumors of many types in medical imaging studies.

[20] Pulmonary tuberculomas may arise due to repeated cycles of necrosis and re-encapsulation of foci, or, alternatively, the shrinkage and fusion of encapsulated densities.

[20] When the size of a brainstem tuberculoma grows to the point of narrowing the fourth ventricle, obstructing hydrocephalus and its related symptoms can arise.

[24][20] The characteristic ring-enhanced appearance is due to lack of blood supply in the central necrotic core that is visualized with injected contrast.

[25] When considering other potential intracranial masses in a differential diagnosis, such as cysticercosis, pyogenic abscess, and neoplastic lesions, tuberculoma can be identified by its larger size (>2 cm), edema, and irregular border.

[22] Tuberculoma is commonly treated through the HRZE drug combination (Isoniazid, Rifampin, Pyrazinamide, Ethambutol) followed by maintenance therapy.

[20] While the majority of tuberculomas resolve in 12–24 months, in patients with multiple or larger lesions prolonged treatment extending beyond two years may be required.

In some patients, the release of inflammatory mediators during treatment can cause a paradoxical worsening of symptoms that is treated with anti-inflammatory medications in addition to the standard anti-tuberculosis regimen.

[22] Exceptionally large tuberculomas, those exerting a mass effect on the brain, and those which fail to respond to medical management required surgical excision.

[22] Reports issued before the advent of effective anti-tuberculosis therapy showed that, when untreated, 30-50% of tuberculomas enter and remain in a stationary course.