When Appearances Deceive: A Case Report of Neurocysticercosis Masquerading As Tuberculoma

Neurocysticercosis (NCC) is a predominant cause of acquired epilepsy globally and often resembles cerebral tuberculoma in neuroimaging, particularly in regions where tuberculosis is prevalent. Diagnostic challenges are exacerbated in resource-limited settings due to financial limitations, restricted access to advanced diagnostic tools, and insufficient longitudinal medical records. We report a case of a 17-year-old immunocompetent female with recurrent generalized seizures who was repeatedly misdiagnosed with cerebral tuberculoma over an eight-year period and treated with multiple courses of anti-tubercular therapy based solely on imaging findings. During the current evaluation, magnetic resonance imaging identified a solitary, small, non-enhancing T2 hypointense lesion with surrounding edema in the right frontal lobe, prompting a differential diagnosis of NCC versus tuberculoma. Negative QuantiFERON-TB Gold (QFT-G, Cellestis Limited, Carnegie, Victoria, Australia) testing, normal chest radiography, absence of systemic tuberculosis, and prior extensive exposure to anti-tubercular therapy favored NCC. Treatment with albendazole and corticosteroids resulted in complete seizure control without recurrence. This case underscores the necessity for meticulous clinic-radiological correlation and increased diagnostic vigilance to prevent misdiagnosis and unnecessary treatment, particularly in resource-constrained environments.