Presentation
Headache and left-sided weakness.
Patient Data
Right temporo-occipital clusters of small cortical coalescent lesions of low T2 signal showing post contrast enhancement. There is surrounding extensive vasogenic edema and mass effect.
The morphological features of the lesions with coalescent ring enhancing nodules, with foci of low T2 signal, were suggestive of cerebral tuberculomas.
Bilateral lower lobar nodular and reticulonodular infiltrates.
Left iliopsoas muscle swelling and subtle low attenuation. Sclerosis of the adjacent vertebral body.
The analysis of pus was positive for M. tuberculosis and negative for other bacterial organisms.
Case Discussion
This case was a bit controversial. MRI features with T2 coalescence, ring-enhancing nodules and the appearance of hypointensity nodules suggested cerebral tuberculoma, but increased choline peaks were suspected as neoplasms by some radiologists. This was also a concern as the patient had a chest CT scan before the tuberculosis test results were available. Pulmonary nodules suggest an inflammatory process rather than a neoplastic process, swelling of the iliopsoas muscle requires another US examination to confirm its nature which appeared cystic, drainage of these muscular cysts revealed pus. The analysis of pus was positive for M. tuberculosis and negative for other bacterial organisms. Finally, complete lab results showed positive sputum for acid-fast bacilli (AFB), and CSF analysis showed high protein, low glucose, and positive AFB results.
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