Meningeal tuberculoma presenting as a space-occupying lesion in an immuno-competent young adult patient: A case report and literature review

Meningeal tuberculoma is a mass-like lesion formed by the immune response to Mycobacterium tuberculosis , involving the brain parenchyma, meninges, or both, that is characterized by central caseous necrosis surrounded by inflammatory cells and fibrosis. It is a rare but serious form of central nervous system (CNS) tuberculosis and can occur with or without tuberculous meningitis. We report a case of a 25-year-old female who presented with seizures and focal neurological deficits. Neuroimaging revealed a ring-enhancing lesion suggestive of a neoplastic process. The patient underwent left frontal craniotomy with gross total resection of the mass, and histopathological examination of the resected specimen confirmed caseating granulomatous inflammation consistent with tuberculoma, with Ziehl–Neelsen staining demonstrating acid-fast bacilli. The patient responded well to anti-tubercular therapy. This case highlights the importance of considering tuberculosis in the differential diagnosis of intracranial mass lesions, especially in endemic regions.