Multiple Intracranial Tuberculomas and Hydrocephalus in an Immunocompetent Patient: A Case Report and Literature Review

Intracranial tuberculomas are a rare and diagnostically challenging form of central nervous system tuberculosis (TB).In this report, we present a case of multiple intracranial tuberculomas in an immunocompetent young adult, accompanied by pulmonary TB and TB lymphadenitis.A 21-year-old male patient was admitted to the hospital with facial numbness and recurrent episodes of speech arrest lasting a few seconds.Radiological imaging revealed multiple intracranial nodular lesions, initially raising suspicion for metastatic disease.However, growth of Mycobacterium tuberculosis in the bronchoalveolar lavage specimen and the finding of necrotizing granulomatous lymphadenitis in the lymph node biopsy led to a presumptive diagnosis of tuberculosis, and a two-month course of quadruple anti-tuberculosis therapy was initiated.Despite this treatment, a ventriculoperitoneal shunt was placed due to hydrocephalus that developed as a result of the mass effect of the cerebellar lesion.The diagnosis was confirmed by the presence of caseating granulomas in the intraoperatively obtained lesion biopsy, detection of Mycobacterium tuberculosis DNA, and positive acid-fast bacilli staining.Following shunt-related complications and progression of the lesion, subtotal resection of the cerebellar mass was performed along with placement of a ventriculoatrial shunt.On follow-up, the patient's clinical findings showed marked improvement.This case highlights the diagnostic and therapeutic challenges of multiple intracranial tuberculomas, even in immunocompetent individuals, and underscores the importance of a multidisciplinary approach in their management.