Tuberculous encephalopathy mimicking limbic encephalitis and large intraparenchymal mass: a challenge in diagnosis

• Main Authors: Haroon, Raihanah, Che Mohamed, Siti Kamariah, Hassan, Radhiana
• Format: Article
• Language: English; English
• Published: Kulliyyah (Faculty) of Medicine, International Islamic University Malaysia 2018
• Subjects: RC111 Infectious and Parasitic Diseases
• Online Access: http://irep.iium.edu.my/86284/1/Poster%20MRS%202018.pdf; http://irep.iium.edu.my/86284/7/929-Manuscript-2402-1-10-20200206.pdf; http://irep.iium.edu.my/86284/; https://journals.iium.edu.my/kom/index.php/imjm/article/view/929/629; https://doi.org/10.31436/imjm.v17i1.929

Central nervous system tuberculosis (CNS TB) was known to manifest as basal exudates, tuberculoma, hydrocephalus, infarctions etc. However, the many faces of tuberculosis may cause atypical imaging characteristics which are extraordinary to clinicians and even to the radiologist interpreting the image. We report a 17-year-old gentleman who presented with acute encephalopathy with neuropsychiatric disturbances. Blood investigations revealed raised total white cell count while CSF fluid revealed high total protein, positive globulin and lymphocytosis. MRI showed haemorrhagic bilateral enhancing basal ganglia lesions. Here, we highlight an extremely rare imaging manifestation of CNS TB which impersonates limbic encephalitis and large intraparenchymal mass imposing a diagnostic dilemma. Hence, radiologists play a central role in the diagnosis of CNS TB in such cases, and careful tailoring of the MRI examination based on the clinical picture of the patient can play a vital role in making the diagnosis, even in atypical presentations Keywords: tuberculous encephalitis, large intraparenchymal mass, tuberculoma