Giant Intracerebral Tuberculoma with Complete Disappearance on Antitubercular Therapy Alone in a Pediatric Case: A Case Illustration with Review of Management Strategy

The Central nervous system can be affected in extrapulmonary tuberculosis. The intracranial tuberculoma occurrence is a rare entity occurrence; most often occur in the form of discrete small multiple lesions. Rarely a large sized tuberculoma is observed with mass effects and usually managed surgically to provide rapid relief of mass effect, histopathological confirmation of diagnosis, reduction of pathological mass thereby increasing efficacy of medical therapy. Author reports an extremely rare case of giant tuberculoma occurring in a pediatric patient, which was managed with antituberculous medication along with cerebral decongestant. The patient was also advised surgical therapy in view of giant size of tuberculoma associated with significant mass effect; however, the parents were unwilling for any form of surgical intervention and finally choose to continue medical treatment alone. After 6 months of antitubercular medical therapy, magnetic resonance imaging brain showed completely vanishing of lesion and also amelioration of mass effect with marked subsidence of perilesional edema correlated very well with marked improvement in the clinical status. He received antituberculous therapy for 24 months. To the best knowledge of authors, the current case represents first case of its kind in the pediatric age group with giant intracerebral tuberculoma responding favorably with medication. Management of such rare case and pertinent literature is reviewed briefly.